Digital Commons Network^™

A Case Study In Program Evaluation, Soma Dutta

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

Program evaluation is a systematic process of assessing a program’s design, implementation, and outcomes to determine its effectiveness, efficiency, and impact, guiding data-driven improvements and decision-making. The Centers for Disease Control and Prevention (CDC) Evaluation Framework provides a structured approach to assessing public health programs, ensuring they are effective, accountable, and continuously improving. By systematically applying this framework, evaluations can provide actionable insights that inform program improvements, guide resource allocation, and ensure that evaluations are practical and meaningful to all stakeholders involved (Centers for Disease Control and Prevention, 2024).

The Bourbon County Health Department (BCHD) has implemented a Physical Activity …

Evaluating A Public Health Program Using The Cdc Framework: A Case Study Approach, Brooke A. Poe

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

In Bourbon County, Kentucky, where rural health challenges and chronic disease burdens persist, a coalition of public health partners set out to improve population-level physical activity through an innovative, community-centered initiative. The Bourbon County Physical Activity Program emerged through collaboration between the Bourbon County Health Department, the University of Kentucky College of Public Health, and UK HealthCare. Together, these partners designed a six-month intervention that combined discounted YMCA memberships, partnerships with employers, a physical activity tracking app with behavioral incentives, and community-wide events to promote accessible and sustained engagement.

Guided by the CDC’s framework for program evaluation in public health, …

Mercury Concentrations, Health, And Marine Food Consumption Across Four Eastern Caribbean Populations: Insights From A Novel Community-Based Study, Russell Fielding, Catherine Brown, Jessica Dutton, Martin S. Forde, Heather Harewood, Lisa Hunt, Catherine Macdonald, Cameron Mewhirter, Vincent Reid, Madison Smith, Holly Taylor, Katelyn Zimmerman

Gulf and Caribbean Research

Mercury (Hg), as an environmental pollutant, can have harmful effects on human health. A common way that people are exposed to Hg is through seafood consumption. This project was designed to investigate Hg exposure through seafood consumption and its health effects among adults in 4 Caribbean countries: Barbados (n = 117), Grenada (n = 90), St. Lucia (n = 126), and St. Vincent & the Grenadines (n = 77). We applied a novel, community—based method, which involved recruiting and paying local barbers and hairstylists to collect hair samples from their clients who consented to join the project as participants. Participants …

Barriers To Postpartum Depression Treatment: Availability And Accessibility Of Maternal Behavioral Health-Inclusive Support Groups For Low-Income Populations, Radhika S. Venkatesan

Honors Undergraduate Theses

The maternal health crisis is a prevalent and concerning issue in the United States. The lack of efficient availability and accessibility to health care services plays a significant role in augmenting this problem. One health care service that is often understudied is support groups, for prevalent issues like postpartum depression. Considering the socioeconomic burdens of low-income mothers, this paper analyzed the accessibility and availability of maternal health support groups across counties in Florida, with varying amounts of individuals below the federal poverty level (%BPL). Essentially, Florida counties were divided into one of four categories depending on their %BPL. A Fisher’s …

Incorporating Social Determinants Of Health Into A Screening Tool Using Machine Learning To Predict Lung Cancer Diagnosis Among High Risk Patients, Bianca Jackson

Theses and Dissertations (ETD)

This research aims to assess the impact of incorporating social determinants of health (SDoH) into prediction screening models for predicting lung cancer among high risk-patients. Lung cancer is typically diagnosed at a later stage when surival and health outcomes are poor. Screening guidelines are currently in place; however, patients at high risk can be missed. There is a need for short-term predictions, to better identify patients at an earlier stage. SDoH features, such as socioeconomic satus, can provide social context that improves identification of patients who might have otherwise been overlooked. The proposed framework includes developing an early detection tool …

A Systematic Review Of Dietary Trends, Influencing Factors, And Their Impacts On Cardiovascular Health In Turkish Populations, Pelin L. Özoğlu

Honors Undergraduate Theses

Cardiovascular disease (CVD) is the leading cause of death globally, including in Türkiye. One key factor influencing CVD prevention is dietary patterns, which directly impacts cardiovascular health. Türkiye traditionally follows the Mediterranean diet (MedDiet), which is acclaimed for its cardiovascular benefits. Despite this, Türkiye continues to experience high rates of CVD, with projections indicating that CVD mortality will double for both men and women by 2030. It is crucial to address diet-related factors, including potential nutritional deficiencies, to reduce cardiovascular health risks.

This research aims to analyze the Turkish community's adherence to the Mediterranean diet to understand why CVD prevalence …

Assessing The Costs Of Illness Attributable To Leptospirosis, Alyssa Chetrick

Public Health Theses

Leptospirosis, caused by the spirochetes of the genus Leptospira, is a zoonotic bacterialdisease endemic to tropical regions and lower middle income countries (LMICs). Leptospirosis causes an estimated 1 million cases and more than 58,900 deaths annually.(Costa et al., 2015; Torgeson et al., 2015) In addition to human health, leptospirosis significantly impacts animal health and the livestock industry, particularly through reproductive losses, increased treatment costs, and decreased milk production, which exacerbates global insecurity.(Bennet, 2015; Torgeson et al., 2015) The estimated global cost loss to productivity due to disease is estimated at Int$ 29.3 billion. (Agampodi et al., 2023) Because of its …

Environmental Justice Dimensions Of Orphaned Oil And Gas Wells In The United States, Grace Marie Hauser

Public Health Theses

Orphaned oil and gas (O&G) wells can leak methane and other hazardous pollutants,contributing to air and water contamination that threatens public health while also imposing financial burdens on local governments and taxpayers for remediation. However, the environmental and public health impacts remain understudied, in part due to limited understanding of the number and location of orphaned O&G wells. In this thesis we aimed to (1) create a national orphaned wells dataset covering years through 2024, (2) estimate the count and distribution of orphaned wells in the United States through 2024, and (3) evaluate the association between community environmental justice (EJ) …

Environmental Gentrification And Health: An Exploratory Analysis Of New York City, Joyce Hu

Public Health Theses

Background: Environmental gentrification is an emerging field seeking to understand the integrated effects of environmental improvements and gentrification. To date, we have a limited understanding of how to analyze environmental gentrification with intersecting health impacts. Our exploratory study investigates this relationship in New York City, where environmental improvement policies coincided with gentrification between 2000-2016. Methods: Using a census tract-level index of gentrification and corresponding environmental exposure data on air quality and vegetation, we conducted a clustering analysis to group and label census tracts according to environmental gentrification patterns. We then performed covariate-adjusted multivariable regression analyses to evaluate the association between …

Assessing Environmental And Sociodemographic Risk Factors For Leptospira Infection In A Urban Informal Settlements: A Study In Salvador, Brazil, Sebastian Alonso Salazar

Public Health Theses

Background: Leptospirosis is a neglected zoonotic disease that disproportionately affects people living in areas with poor sanitation, water contamination and rodent infestation such as urban informal settlements. More than one billion people worldwide reside in such communities, and with increasing urbanization, coupled with environmental change, the risk of Leptospira transmission continues to increase. Despite its global burden, this disease is often underreported due to diagnostic challenges and limited healthcare access, particularly in urban informal settlements. Understanding the incidence and risk factors in these settings is essential for improving public health interventions. This study aims to estimate the annual incidence of …

Examining Healthcare Access Disparities: Social Determinants And Patient Experiences At Valley Healthcare, Mikaila Larmond

Theses and Dissertations

Persistent disparities in healthcare access continued to affect low-income, rural, and underserved populations across the United States. This capstone project explored these disparities within Valley HealthCare, a regional provider in Columbus, Georgia, by examining how social determinants such as income, education, geography, and transportation shaped healthcare engagement among adult patients. A mixed-methods case study design was used to analyze survey data, patient satisfaction feedback, and organizational reports from a sample of 80 adult patients between January and March 2025.

The results showed that patients residing in lower-income or geographically isolated areas reported significantly higher rates of missed appointments. Individuals with …

Changing Climate, Changing Health: Perspectives From General Population In Mysuru, Lekhashree A, Manirsha P V, Paranthaman Chinnasamy, Srishti Arya, Sunil Kumar D

Digital Journal of Clinical Medicine

Background: Climate change has emerged as a major public health concern, contributing to rising morbidity and mortality worldwide. In India, increasing heat waves, unpredictable rainfall, and deteriorating air quality have intensified climate-sensitive health conditions. This study aims to assess the health impacts of climate change among the general population of Mysuru.

Methodology: A community-based cross-sectional study was conducted among 400 residents of Mysuru (April–June 2024). Participants were recruited through simple random sampling. Data were collected using a pre-tested semi-structured questionnaire via Google Forms. Analysis was performed using SPSS v26, with descriptive and inferential statistics.

Results: Among 400 participants, …

Community-Level Factors Influencing The Duration Of Buprenorphine Treatment In Individuals With Opioid Use Disorder: A Cohort Study Using Us Longitudinal Claims Data, Paula A Jaimes-Buitron, Kehe Zhang, Yanmin Gong, Yuanxiong Guo, Cici Bauer, Carolina Vivas-Valencia

Faculty, Staff and Student Publications

Introduction: Buprenorphine is effective in reducing opioid-related morbidity and mortality; however, many patients discontinue treatment prematurely. While previous research has focused on individual-level predictors of retention, the influence of community context remains underexplored. This study aims to examine how community-level factors, such as social vulnerability, availability of buprenorphine-waivered providers and access to behavioural health services, affect the duration of buprenorphine treatment episodes for individuals with opioid use disorder (OUD).

Methods: We conducted a retrospective cohort study using longitudinal claims data from 2006 to 2022. Adults aged 18 and older who initiated buprenorphine treatment for OUD and maintained continuous enrolment were …

Large-Vessel Occlusion Stroke Knowledge And Training For Stroke Severity Assessment Among Emergency Medical Services Personnel In The United States, Kaiz S Asif, Robin Novakovic, Thanh N Nguyen, Santiago Ortega-Gutierrez, Youngran Kim, Amanda Jagolino-Cole, Sushanth Aroor, Alicia Castonguay, Prateek Kumar, Ashutosh P Jhadav, Dileep Yavagal, May Nour, Gabor Toth, Maxim Mokin, Sunil A Sheth, Mouhammad A Jumaa, Alhamza Al-Bayati, Mohamed Teleb, Ossama Y Mansour, Shashvat M Desai, Joshua Hartman, David S Liebeskind, Ameer E Hassan, Brijesh P Mehta, Svin Education And Speed Committees

Faculty, Staff and Student Publications

Background: Prehospital identification of large-vessel occlusion (LVO) stroke facilitates the development of a regional triage protocol that could lead to an improvement in intrahospital and interhospital workflows. This requires stroke education of emergency medical services (EMS) personnel to improve stroke recognition, severity assessment, and prenotification. However, the current state of EMS personnel's knowledge of LVO stroke, their training for stroke severity assessment, and their preferences for educational methods are unknown. We conducted a nationwide EMS survey across the United States to glean insights that can inform and customize future EMS educational efforts.

Methods: The Society of Vascular and Interventional Neurology, …

A Comparison Of Floating Catchment Area Parameters With Applications To A Dataset Of Clinics Enrolled In A Statewide Child And Adolescent Psychiatric Consultation Program, Jocelyn Hunyadi, Lara S Savas, Kehe Zhang, Jeanette E Deason, Ryan Ramphul, Melissa F Peskin, Erica L Frost, Cici Bauer

Faculty, Staff and Student Publications

INTRODUCTION: Healthcare resources are often crucial but limited, requiring careful consideration and informed allocation based on population needs and potential healthcare access. In resource allocation settings, availability and accessibility of resources should be examined simultaneously. The two-step floating catchment area (2SFCA) method has been previously used to evaluate spatial accessibility to healthcare resources and services, and to address health-related disparities. The 2SFCA methods have regained significant popularity during the COVID-19 pandemic, as their application proved crucial in addressing priority public health data analysis, modeling, and accessibility challenges. However, comprehensive comparisons of the 2SFCA method input parameters in the context of …

Clarification Of Public Health Pathways Toward Clinical Careers: A Pilot Study Describing A Benchmark Analysis Project, Elizabeth A. Brown, Melissa Feliciano, Daniel Martinez

Health Behavior, Policy & Management Faculty Publications

Introduction: Undergraduate public health programs have adapted the required basic sciences based on medical and technological advances and the needs of the public health workforce. We aim to demonstrate how a benchmark analysis project was used to improve curriculum and develop a model where basic sciences in public health can be used to build pathways to clinical graduate programs like medicine, pharmacy, physician assistant, etc.

Methods: Authors conducted a benchmark analysis of Bachelor of Science in Public Health (BSPH) Degrees (or public health-related degrees) in the southern region of the United States (US) to explore required basic sciences. Authors searched …

Weighted Family History Density Of Substance Use: Influence On Participant Substance Use Onset, Escalation, And Duration, Carleigh A. Litteral

Theses and Dissertations--Psychology

Substance use disorders impose a staggering toll on the United States (U.S.), straining healthcare systems, destabilizing communities, and profoundly impacting both individuals and families. Approximately one in six Americans aged 12 and older had a past-year substance use disorder in 2022 (Key Substance Use, 2022), and nearly one-third of adults experience a substance use disorder in their lifetime (Wu, 2010), contributing to an economic burden exceeding $400 billion annually (National Drug Threat Assessment, 2011). Family history of substance use disorders is a key predictor of vulnerability, with individuals who have affected relatives being 2–8 times more …

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 …

Exploring The Reassessment Of Palliative Home Care Clients: A Mixed Methods Study, Maya Canham

Theses and Dissertations (Comprehensive)

Introduction: The timely reassessment of clients receiving palliative home care (HC) is critical for supporting clinicians with care planning and service delivery. However, there is little information on the frequency of reassessments and factors driving reassessment in palliative HC clients.

Objectives: The objectives of this study were to: (i) determine the proportion of palliative HC clients reassessed with the interRAI Palliative Care (interRAI PC) instrument, (ii) calculate the average interRAI PC reassessment interval, (iii) identify the key factors driving interRAI PC reassessment at various intervals, and (iv) explore the factors that influence palliative HC clinicians to reassess their clients in …

Politics In Public Health: Growing Partisan Divides In Covid-19 Vaccine Attitudes And Uptake Post-2021 Presidential Inauguration, Hongbin Fan, Zhongliang Zhou, Guanping Liu, Chi Shen, Qi Zhang

Epidemiology, Biostatistics, & Environmental Health Faculty Publications

Objectives: To investigate whether the 2021 U.S. presidential inauguration contributed to a widening of partisan divides in COVID-19 vaccine attitudes and uptake. Methods: We leverage the presidential inauguration as a natural experiment and analyze data from the Household Pulse Survey and CDC vaccination records. Using a difference-in-differences framework with continuous treatment, we examine how the transition differentially affected state-level vaccine refusal rates and county-level vaccination rates, based on varying levels of partisanship as measured by the Trump-Biden vote gap. Results: Following Biden's inauguration, vaccine refusal declined more in pro-Biden states. Distrust in government and vaccines accounted for approximately 80% of …

Pediatric Cancer Incidence, Temporal Trends, And Mortality In The United States By Health Disparities Indicators, Seer (1973-2014), Prachi P. Chavan, Laurens Holmes Jr.

Epidemiology, Biostatistics, & Environmental Health Faculty Publications

Background: Pediatric cancer incidence has been increasing in the United States, despite improvement in pediatric cancer survival. This steady increase in incidence trends is not completely understood but maybe associated with social and environmental factors. In this study we aimed to assess the cumulative incidence, temporal trends, and mortality rates in pediatric cancer. Additionally, we examined sub-group variability in both incidence and mortality rates. Methods: Data from Surveillance, Epidemiology, and End Results (SEER) −18 from 1973–2014 were used for the purpose of analysis in this study. Age-adjusted incidence rates were used to assess temporal trends in cancer among children aged < 1–19 years. Univariable and multivariable binomial regression models were used to examine the association between race and cancer mortality while adjusting for potential confounders. Results: There were 92,594 cancer diagnoses during this period. White children comprised 74,758, (80.7%), black children 10,030, (10.8%), and other races 6648, (7.2%). Overall the age-adjusted cumulative incidence was slightly higher among white children (16.4%) than black children (12.4%) and other (13.0%). Children aged 15–19 years and those in metropolitan regions were more likely to be diagnosed with pediatric cancer. Relative to females, males were 16% more likely to die from the disease [adjusted Risk Ratio (aRR): 1.16, 95% Confidence Interval (CI): 1.09–1.22]. Additionally, compared to white children, black children had higher mortality rates [(aRR): 1.37, 99% CI: 1.23–1.52]. Conclusions: There is an increasing trend in pediatric cancer incidence; while white children have the highest incidence, black children and males indicated a survival disadvantage, indicative of racial and sex variability in overall pediatric cancer in the United States.

Impact Of Rurality On Health Care Utilization Among Australian Residents From 2009 To 2021, Engida Yisma, Martin Jones, Lee San Pauh, Sandra Walsh, Sara Jones, Esther May, Marianne Gillam

Research outputs 2022 to 2026

Purpose: In Australia, there is limited research regarding the effect of rurality on health care utilization using longitudinal data.

Methods: We analyzed data from four annual waves (2009, 2013, 2017, and 2021) of the longitudinal Household, Income and Labour Dynamics in Australia (HILDA) Survey to examine changes in the health care utilization over time among urban and rural residents. Poisson regression models estimated adjusted incidence rate ratios (aIRR) and 95% confidence intervals (CIs) for rural versus urban residents, accounting for a range of health-related and sociodemographic characteristics. Health care utilization was measured using four key indicators: visits to family doctor …

Differences In Mental Health Care Use Between Urban And Rural Populations In New York State, 2017-2022, Anna J. Papa

Electronic Theses & Dissertations (2024 - present)

Objective

This study aimed to determine whether rural New York State residents receive mental health care at the same rate as urban residents, how poverty rates in New York State relate to rurality and mental health care use, and how pre-pandemic mental health care use rates compare to 2022 use rates. The goal was not to estimate the burden of disease, nor to estimate the number of patients engaged in care in each zip code, but to highlight the potential differences in service use between urban and rural New York State Office of Mental Health clients.

Methods

A secondary analysis …

Theoretical Foundations And Applied Performance Of Periodicity-Aware Imputation: Variable Bandpass Block Bootstrap Methods For Incomplete Time Series, Asmaa Ahmad

Electronic Theses & Dissertations (2024 - present)

Time series data are prevalent across a wide range of disciplines, including health surveillance, public policy, and environmental monitoring. In the presence of underlying cyclical patterns, the integrity of time series analysis depends critically on the ability to detect, model, and impute structured missing data without compromising the temporal structure. This dissertation introduces and validates a novel imputation framework that integrates the Variable Bandpass Periodic Block Bootstrap (VBPBB) into multiple imputation procedures, improving the accuracy, robustness, and interpretability of time series models under high rates of missingness and noise. The overarching goal of this dissertation was to develop and evaluate …

The Relationship Between Food Insecurity And Low Birthweight Across Us Counties And Related Racial Disparities, Marissa A. Beldon, Shondra L. Clay, M. Courtney Hughes, Kathryn Mazurek

Faculty Articles, Papers, and Other Scholarship

Objective

To explore the relationship between low birthweight (LBW) and food insecurity across US counties and determine whether this relationship differs between Black and White women.

Methods

LBW data was derived from the 2013–2019 National Center for Health Statistics and National Vital Statistics System Birth Files. Food insecurity data was derived from Feeding America’s 2013–2019 Map the Meal Gap project. Analyses included descriptive statistics and regression models.

Results

Data were available for 3037 US counties. Food insecurity significantly predicted county-level LBW (t(3035) = 44.48, P <  .001) and explained 39.46% of the variance in LBW (F(13,035) = 1978.03, P <  .001, R = .63). Food insecurity predicted LBW for …

Investigating Socioeconomic Deprivation And Antibiotic Prescribing Among Older Medicare Patients Using An Instrumental Variable Approach, Mayar Al Mohajer, David Slusky, David Nix, Catia Nicodemo

Faculty, Staff and Students Publications

Background: Socioeconomic deprivation has been associated with antibiotic overprescription in the US; however, prior studies could not quantify a causal relationship due to endogeneity. This study examines how socioeconomic deprivation is related to the rate of antibiotic days supplied to older Medicare Part D beneficiaries, utilizing an Instrumental Variable (IV) approach.

Methods: Data from the Medicare Part D and the Social Deprivation Index (SDI) repositories were analyzed. To address potential endogeneity and omitted variable bias in the relationship between SDI and antibiotic prescribing, we used the maximum Earned Income Tax Credit as an IV. Bivariate Moran's I assessed the spatial …

Factors Affecting Early Marriage In Dau District, Malang Regency, Agus Tiyaningsih, Endyka Erye Frety, Rize Budi Amalia, Budi Prasetyo

Preventia: The Indonesian Journal of Public Health

Indonesia still in 8th largest early marriage rate in the world. Many factors cause early marriage to occur, therefore this study aims to analyze the factors that influence early marriage in Dau District, Malang Regency. To analyze the factors that influence early marriage in Dau District, Malang Regency. The design of this study was observational analytic use Cross Sectional approach. The population in this study were women who married in 2022 in Dau District of Malang Regency, amount 511 women and the sample were 60 women. The independent variables in this study are education, family income, surrounding cultural beliefs, peers, …

Multi-Sensor Data Fusion And Gis-Drastic Integration For Groundwater Vulnerability Assessment With Rainfall Consideration, Wu Jiazhe, Dai Xinrui, Su Yangcheng, Zheng Xiangtian, Bushra Ghaffar, Rabiya Nasir, Ahsan Jamil, Zeeshan Zafar, Mohammad Suhail Meer, M. Abdullah-Al-Wadud, Rahila Naseer, Hesham El-Askary

Mathematics, Physics, and Computer Science Faculty Articles and Research

In many areas of the world, particularly in arid and semi-arid regions, groundwater is the primary source of fresh water, and it supplies around one-third of the world's fresh water. Agriculture is the primary economic sector on the coast in the southern district (Nowshera). More food productivity is required due to the expanding population and diminishing agricultural lands, which increases the use of chemical pesticides and fertilizers in farming. The current study was conducted in northwestern parts of Pakistan to evaluate the impacts of the frequent use of pesticides and fertilizers in agricultural fields. Nine hydrogeological parameters were considered, and …

From The Ocean To Our Kitchen Table: Anthropogenic Particles In The Edible Tissue Of U.S.. West Coast Seafood Species, Summer D. Traylor, Elise F. Granek, Marilyn Duncan, Susanne Brander

Environmental Science and Management Faculty Publications and Presentations

Microplastics (MPs) and other anthropogenic particles (APs) are pervasive environmental contaminants found throughout marine and aquatic environments. We quantified APs in the edible tissue of black rockfish, lingcod, Chinook salmon, Pacific herring, Pacific lamprey, and pink shrimp, comparing AP burdens across trophic levels and between vessel-retrieved and retail-purchased individuals. Edible tissue was digested and analyzed under a microscope, and a subset of suspected APs was identified using spectroscopy (μFTIR). Anthropogenic particles were found in 180 of 182 individuals. Finfish contained 0.02–1.08 AP/g of muscle tissue. In pink shrimp (Pandalus jordani), the average AP/g was 10.68 for vessel-retrieved and …

Dental Clinic Deserts In The Us: Spatial Accessibility Analysis, Md Shahinoor Rahman, Jeffrey C. Blossom, Ichiro Kawachi, Renuka Tipirneni, Hawazin W. Elani

School of Public Health Faculty Publications

IMPORTANCE: Little is known about the spatial accessibility to dental clinics across the US. OBJECTIVE: To map the spatial accessibility of dental clinics nationally and to examine the characteristics of counties and US Census block groups with dental care shortage areas. DESIGN, SETTING, AND PARTICIPANTS: Cross-sectional study of US dental clinics in 2023 using data from the IQVIA national practitioners' database, which includes 205 762 active dentists. Data were analyzed from November 2023 to April 2024. EXPOSURES: Socioeconomic characteristics of block groups and counties including rurality, area deprivation, racial and ethnic segregation, and uninsured population. MAIN OUTCOMES AND MEASURES: Enhanced …