Digital Commons Network^™

Diet Quality As Assessed By The Healthy Eating Index-2020 Among Individuals Diagnosed With And Without Type 2 Diabetes, Minghao Zhou, Hairui Yu, Renee Underwood, Hongning Cai, Tung Sung Tseng, Susu Luo

School of Public Health Faculty Publications

Background: Dietary management is key to preventing and controlling type 2 diabetes mellitus (T2DM). However, few studies have examined differences in Healthy Eating Index (HEI-2020) scores and components among individuals with and without diagnosed T2DM. This study aimed to assess gender differences in HEI-2020 scores and its 13 components by T2DM status. Methods: Using National Health and Nutrition Examination Survey (NHANES) data from 2011 to 2018, this cross-sectional study analyzed 19,464 adults. Diagnosed T2DM was identified via self-report or diabetes medication use. Diet quality was assessed using the HEI-2020, scored from 0 to 100, with a higher HEI score indicates …

Nourishing Births: A Program Evaluation Proposal For Community-Based Nutrition Education, Food Access, And Garden Engagement Among Black Birthing People, Naa Deedei-Vera Hammond

Master's Projects and Capstones

Black birthing people in the United States continue to experience unequal maternal health outcomes, shaped in part by racism and barriers to nutritious food, culturally relevant health education, and supportive community spaces. While prenatal nutrition education and food assistance programs can provide important resources, information alone cannot address the challenges many people face when trying to access healthy and affordable food during pregnancy. The Nourishing Births Initiative is a proposed community-based maternal health program designed to respond to these needs by bringing together prenatal nutrition education, help connecting to food resources, community gardening, and peer support for Black birthing people …

Knowledge, Attitudes, And Practices (Kap) Of Parents Regarding The Prevention And Control Of Childhood Iron Deficiency Anemia In Egypt: A Cross-Sectional Study, Omnia Soliman

Theses and Dissertations

Childhood Iron Deficiency Anemia (IDA) remains a major public health challenge in Egypt, where its persistently high and rising prevalence carries substantial consequences for child growth, cognitive development, immunity, and long-term health outcomes. Globally, approximately 40% of children aged 6–59 months are affected by anemia (World Health Organization, 2025), and Egypt mirrors this burden, with national data showing a worsening trend in recent years. In Egypt, national strategies have traditionally focused on biomedical interventions such as iron supplementation and food fortification, while less attention has been directed toward behavioral and household-level determinants, particularly parental knowledge, attitudes, and practices (KAP) related …

Local Government Policies Restricting Unhealthy Outdoor Food Advertising In Australia: Stakeholder Perspectives Identify Political Willingness Is Key To Overcoming Barriers, Alexia Bivoltsis, Frith Klug, Jacinta Francis, Clare Whitton, Gina S.A. Trapp, Claire E. Pulker

Research outputs 2022 to 2026

Background: Unhealthy outdoor food advertising is strongly linked to poor diet, highlighting the need for policies. Western Australian (WA) local governments (LGs) can restrict advertising on their owned infrastructure through their Public Health Plans, but limited policy action has occurred. This study aimed to explore the perspectives of WA LGs and public health organizations (PHOs) on current and potential policies restricting unhealthy outdoor food advertising on LG owned infrastructure to (1) identify barriers and enablers to the policy making process, (2) assess the current level of political willingness (i.e. political want, political can and political must) and (3) inform development …

Weathering The Divide: Social Determinants, Neighborhood Context, And Systemic Lupus Erythematosus Among African American Women, Vanessa Cl Morman

Electronic Theses and Dissertations

Background: Systemic lupus erythematosus (SLE) disproportionately affects African American women and contributes to racial health disparities in the United States. Although genetic susceptibility influences disease risk, growing evidence suggests that social determinants of health (SDOH), including neighborhood conditions, structural racism, and socioeconomic disadvantage, contribute to disease development and progression. Epigenetic mechanisms may provide a biological pathway linking adverse social conditions to chronic disease disparities. This dissertation examined the influence of SDOH on SLE disparities through evidence synthesis and empirical investigation to inform public health practice and policy.

Methods: This integrated learning experience consisted of three complementary manuscripts. Aim 1 was …

Slushies Before School: Exploring How Nearby Food Outlets Impact The Eating Behaviours Of Secondary Students In Perth, Western Australia, Sharonna Mossenson, Klug, Joelie Mandzufas, Jacinta Francis, Siobhan Hickling, Lukar Thornton, Gina Trapp

Research outputs 2022 to 2026

The external school food environment, comprising food outlets and marketing near schools, shapes what young people eat. Yet little is known about how Australian adolescents perceive and navigate these environments. Focus groups were conducted with 31 school students (Years 7–12) from Perth, Western Australia, to explore their experiences of the external school food environment and its influence on their food-related behaviours. Transcripts were thematically analysed and six themes were identified. Accessibility emphasised proximity, transport links, opening hours and speed of service, with older students using outlets as social spaces. Availability of slushies, energy drinks, snacks and fast-food meal deals influenced …

Temptation At The School Fence: A Qualitative Exploration Of The Impact Of External Food Outlets On The School Community, Sharonna Mossenson, Klug, Jacinta Francis, Siobhan Hickling, Lukar Thornton, Gina Trapp

Research outputs 2022 to 2026

Retail food outlets are commonly located in close proximity to schools, providing students with opportunities to purchase and consume food enroute to or from school. These outlets are typically unhealthy and disproportionately clustered near schools, and this trend has been increasing over time. While quantitative studies have established associations between school food environments and adolescent dietary behaviours, little is known about how school personnel perceive and experience their impacts. This qualitative study explored perspectives of school personnel (n = 9) from a secondary school in Perth, Western Australia, located 150 m from two retail food precincts (areas with a high …

Implementation And Effectiveness Of A Food Education Intervention To Promote Plant-Based Foods: A Partially Cluster-Randomized Controlled Trial, Henna Vepsäläinen, Satu Kinnunen, Sari Niinistö, Leena Forma, Suvi T. Itkonen, Tuuli E. Korhonen, Liisa Korkalo, Heli Kuusipalo, Jelena Meinilä, Kaija Nissinen, Susanna Raulio, Ros Sambell, Mari Åkerlund, Suvi M. Virtanen, Maijaliisa Erkkola

Research outputs 2022 to 2026

Background: Legumes can substitute for meat and are thus a particularly important food group for environmental sustainability. As the use of legumes among Finnish children is marginal, there is potential for a substantial increase in their consumption. However, food education delivered through early childhood education and care (ECEC) settings has rarely focused specifically on environmentally sustainable foods, such as legumes. This study describes the implementation and effectiveness of an ECEC-delivered food education intervention within the FoodStep study. Methods: The partially cluster-randomized FoodStep intervention aimed to increase the supply of vegetables, legumes, fruits, berries, and sustainable fish while reducing the provision …

Living Next Door To Mcdonald’S: A Qualitative Study Of Community Submissions And Resident Realities Pre- And Post Development, Roslyn Giglia, Jacinta Francis, Jana Buckle, Clare Whitton, Ros Sambell, Frith Klug, Lukar Thornton, Siobhan Hickling, Katherine Kent, Gina Trapp

Research outputs 2022 to 2026

Background: The proliferation of fast-food outlets (FFOs) in residential areas has raised growing concerns about their impact on community health, safety, and wellbeing. This qualitative study examined both pre-development community consultation submissions and post-development resident experiences surrounding the development of a McDonald’s outlet in a newly established suburb on the urban fringe of Perth, Western Australia (WA). Methods: Using a qualitative descriptive design, the study analyzed 183 community submissions lodged with the local council prior to development and conducted semi-structured interviews with 11 residents living within 300 m of the outlet after construction. Results: Content analysis revealed strong opposition, with …

Virginia Team Nutrition Training Grant Workshop Participation Increased Intention To Change In Specific Topics, Rachel A Liebe, Kathleen J Porter, Valisa Hedrick, Elena Serrano, Kelly Shomo, Sandra Curwood, Sarah Misyak

Journal of Extension

Team Nutrition is implemented nationally to improve school food environments. Yet evidence on factors impacting implementation is limited. This study aimed to evaluate the execution of the Team Nutrition Training Grant (TNTG) in Virginia elementary schools using the RE-AIM (Reach, Efficacy, Adoption, Implementation, Maintenance) framework. The TNTG grant was implemented through two train-the-trainer workshops that were conducted with school nutrition directors (SNDs). Overall, SNDs from 84% of school divisions attended at least one workshop. Intention to change increased significantly from pre- to post- for both workshops in some target areas. This evaluation could help practitioners guide the development of evaluation …

Burden And Prioritization Of Airborne Diseases In Bogor City, 2024: A Situational Analysis, Tuti Alawiyah, Helda Helda, Menikha Maulida

Jurnal Epidemiologi Kesehatan Indonesia

Indonesia, particularly urban agglomeration areas such as Bogor, continues to face major challenges related to air quality, resulting in an increased risk of airborne disease transmission. This study aimed to assess the burden of airborne diseases and determine health problem priorities in Bogor City using surveillance data from 2022 to October 2024. A descriptive epidemiological study was conducted in Bogor City using surveillance data from 2022 to 2024. Health problem prioritization was performed using the Pan American Health Organization (PAHO)-adapted Hanlon method through structured questionnaires administered to an expert panel consisting of health office officials and heads of primary healthcare …

Descriptive Epidemiology Of Tuberculosis Case With Diabetes Mellitus Identified Through Screening Activities In Indonesia, 2024, Chrisshanti Putri Pasaribu

Jurnal Epidemiologi Kesehatan Indonesia

Tuberculosis (TB) remains a major public health problem, particularly among individuals with diabetes mellitus (DM), who are at an increased risk of developing TB disease. Screening activities conducted through health facility-based screening and active case finding (ACF) provide opportunities to identify TB cases with DM comorbidity. This study aimed to describe the epidemiological characteristics of TB-DM cases identified through screening activities in Indonesia in 2024. This descriptive study used routine secondary program data obtained from the Tuberculosis Information System (SITB). The source population consisted of 615,357 individuals screened for TB in 2024, among whom 14,727 TB cases were identified. Of …

Situational Analysis Of Maternal And Child Health Problems In Dki Jakarta Province In 2024, Jennifer Irene Amorita Hadiono, Helda Helda, Tri Yunis Miko Wahyono, Inggariwati Inggariwati

Jurnal Epidemiologi Kesehatan Indonesia

Maternal and child health (MCH) is a critical indicator of national health development aligned with SDGs targets. DKI Jakarta, as a densely populated capital city, faces unique challenges in providing equitable MCH services. This study aims to analyze the situational status of MCH problems in DKI Jakarta Province in 2024 and to determine health priorities using the PAHO-adopted Hanlon method. A descriptive study using quantitative and qualitative approaches was conducted at the DKI Jakarta Provincial Health Office from October 2024 to January 2025. Primary data were collected through structured interviews, while secondary data were sourced from reports of the Nutrition …

Psychosocial And Demographic Determinants Of Work Stress Among Lecturers At University X, Natasha Putri Ayu Kayla, Fajaria Nurcandra, Dr. Dyah Utari, Nayla K. Fithri, Siti Norashikin Mohamad Shaifuddin

Jurnal Epidemiologi Kesehatan Indonesia

Occupational stress is a psychological pressure related to work conditions. Psychosocial and demographic determinants may be the influence. Lecturers are white collar workers who have the opportunity to experience occupational stress. The aim of this study is to determine the factors that influence occupational stress among lecturers in X University. This research is a quantitative study with a cross-sectional study design. The sampling technique used is Accidental Sampling. The number of samples used was 132 respondents. The study was conducted in April-June 2024. The Cox Regression Model was used to analyze. The instruments used were The Workplace Stress Scale, Multidimensional …

An Evaluation Of Southern Nevada’S Pediatric Care Ecosystem, David Damore, Tina Quigley, Nick Fiore

Policy Briefs and Reports

In 2024, The Lincy Institute and the Nevada Health and Bioscience Corporation released a report prepared by the consulting firm Tripp Umbach detailing the case for a stand-alone children’s hospital in Southern Nevada. Shortly thereafter, Intermountain Health announced it would build Nevada’s first such facility in Las Vegas, expected to open in 2030. To complement the hospital’s development, The Lincy Institute undertook an independent evaluation of the regional pediatric care landscape. The analysis draws on secondary data and discussions with advocates, health system administrators, practitioners, and providers. The report examines:

• Fiscal, resource, and workforce challenges underlying Nevada’s poor population-level pediatric …

Intimate Partner Violence And Child Wasting Across Countries: An Ecological Cross-Sectional Study, Wanri Lumbanraja, I Ketut Kasta Arya Wijaya, Ruben Cornelius Siagian

Journal of Indonesian Health Policy and Administration

Intimate partner violence (IPV) is a public health issue that can affect the well-being of women, their families, and the child-rearing environment. Meanwhile, wasting in under-five children reflects acute malnutrition linked to food insecurity, infectious diseases, poverty, and access to healthcare services. This study aimed to analyze the relationship between the prevalence of IPV among women in the past 12 months and the prevalence of wasting in children under the age of five at the national level. This study addresses the gap in cross-national research, which remains limited in linking IPV as an indicator of social vulnerability with wasting as …

Faktor-Faktor Yang Berhubungan Dengan Kejadian Prediabetes Pada Perawat Di Rumah Sakit X Tahun 2025, Putri Nurhaliza, Chandrayani Simanjorang, Agung Raharjo

Jurnal Biostatistik, Kependudukan, dan Informatika Kesehatan

Prediabetes dapat berkembang menjadi diabetes melitus dan meningkatkan risiko penyakit kardiovaskular. Selain itu, beban ekonomi juga meningkat akibat tingginya biaya pelayanan kesehatan dan penurunan produktivitas kerja. Salah satu kelompok berisiko prediabetes adalah perawat karena karakteristik pekerjaannya, seperti penerapan sistem kerja sif serta tingginya beban dan tekanan kerja yang dapat memicu stres. Penelitian ini dilakukan untuk mengidentifikasi faktor-faktor yang berhubungan dengan kejadian prediabetes pada perawat di Rumah Sakit X pada tahun 2025. Desain studi yang digunakan adalah cross-sectional dengan sumber data primer yang dikumpulkan melalui pengisian kuesioner dan data sekunder yang diperoleh dari laporan hasil medical check-up tahun 2025. Populasi dalam …

Harmonies Of Healing: A Secondary Data Analysis On Music Engagement And Quality Of Life In Older Adults, Theophilus Eben Nartey

Doctoral Dissertations and Projects

The purpose of this quantitative, cross-sectional secondary data analysis was to examine the relationship between music engagement and self-reported quality of life among adults aged 60 years and older, using data from the Health and Retirement Study (HRS). Guided by the Biopsychosocial-Spiritual (BPSS) framework, the study explored whether music engagement significantly predicted perceived well-being in later adulthood while accounting for chronic health conditions. Secondary data from the HRS public-use dataset were analyzed using IBM SPSS Statistics Version 29. The final analytical sample consisted of 1,582 adults aged 60 years or older with complete data on all variables included in the …

Barriers And Facilitators To Health Literacy Among Black Americans With Overweight And Obesity In South Carolina: A Mini-Ethnographic Study, Shelly Campbell-Timmons

Doctoral Dissertations and Projects

The purpose of this qualitative mini ethnography adapted from traditional ethnography with limited time and scope, was to explore and understand perceptions of barriers and facilitators to health literacy among Black Americans with overweight and obesity in three South Carolina counties. Population data showed that approximately 40.3% of U.S. adults are obese. Moreover, Non-Hispanic Black communities are disproportionately affected by overweight and obesity despite efforts to combat the weight-related health risk. Still, limited health literacy should be the focus of public health strategies like teach-back and plain language communication, to address overweight and obesity prevalence and disparities. The study was …

A Mixed Methods Study Of Inpatients’ Experiences, Priorities, And Health-Related Quality Of Life During High- Flow Nasal Cannula Therapy, Cintamani H. Ellsworth, Rebecca S. Bartlett

Journal of Patient-Centered Research and Reviews

Purpose: High-flow nasal cannula (HFNC) is an oxygen delivery method with numerous benefits for severely ill patients. There is a paucity of research focused on the perspectives of patients receiving HFNC oxygen therapy. This study aimed to engage with patients to gain a clearer understanding of their experiences, priorities, and health-related quality of life.

Methods: A cross-sectional, mixed methods study was completed with 10 adult inpatients who had received HFNC oxygen therapy during their hospital admission. Semi-structured interviews and the Patient Reported Outcomes Measurement Information System (PROMIS) Global Health Scale were used to identify participant perceptions of their physical and …

Under Pressure And Underrecognized: The Role Of Social Workers And Case Managers In Screening For Social Determinants Of Health In The United States, Melissa L. Habrat, Lindsay D. Nelson, David A. Nelson

Journal of Patient-Centered Research and Reviews

Social determinants of health (SDOH) screening is increasingly embedded in clinical care, yet the work of asking, documenting, and responding to social needs often falls to social workers and nurses or professional case managers who operate under significant time, staffing, and system constraints. We conducted a narrative review to examine how SDOH influence outcomes, identify systemic and emotional barriers to effective screening, and synthesize evidence-informed strategies that support implementation. Across included sources, findings clustered into three domains: challenges in integrating screening (policy and accreditation pressure, staffing and resource constraints, EHR documentation and interoperability limits, closed-loop referral and cross-sector partnership gaps, …

Strengthening Health System-Community Partnerships To Address Pediatric Social Needs: A Qualitative Study, Joy Friedman, Melissa A. Alderfer, Kelsey Higgins, Aaron Carpenter, Jennifer Sciolla, Sarah E. Wawrzynski

Department of Pediatrics Faculty Papers

IntroductionStructural and social conditions influence pediatric health outcomes. Successful implementation of social needs screening and referral programs depends on community-based organizations (CBOs) to provide resources that address health-related social needs (HRSN). We explored current practices and perspectives of health care workers and CBO representatives on improving health system-CBO partnerships.MethodsParticipants were purposively recruited from a variety of health care settings involved in HRSN screening and CBOs delivering resources in the community. Participants completed semi-structured interviews. Qualitative thematic analysis was used to summarize data.ResultsTen key informants participated (six health care workers and four CBO representatives). Four themes were identified: 1) mismatches in …

Precision Approaches Improve Community Health, Roger A. Rennekamp, David Buys

Journal of Extension

Recent advances in data science provide Extension practitioners with access to data sorted by zip code, census tract, or neighborhood. Such hyper-local data now allows Extension personnel to assess community needs and assets at a more granular level and focus their work on the people and communities of greatest need. In this article, we introduce an approach we refer to as precision public health. Using such a precision approach to community assessment and, ultimately, programming can save money, increase the likelihood of producing measurable results, and create more manageable workloads for county-based Extension personnel.

Gene-Environment Interactions In Cardiovascular Aging: Volunteering, Polygenic Risk, And Biomarker Change In European And African Ancestry Populations, Seoyoun Kim, Byeongju Ryu, Erin Ware, Koichiro Shiba, Cal J. Halvorsen

Brown School Faculty Publications

Volunteering has been associated with better cardiovascular health, but whether this association varies by genetic susceptibility to cardiovascular disease remains unclear. This study examined associations between volunteering and cardiovascular biomarkers, assessed associations between biomarker-specific polygenic scores (PGSs) and these outcomes, and tested whether polygenic risk moderated volunteering–biomarker associations among U.S. adults aged 51 years and older.

Cardiovascular Disease Incidence And Cancer Risk In Two Large European Prospective Cohorts, Emma Fontvieille, Vivian Viallon, Laia Peruchet-Noray, Quan Gan, N. Charlotte Onland-Moret, Yvonne Koop, Anne Tjønneland, Nicola Bondonno, Verena Katzke, Rudolf Kaaks, Matthias B. Schulze, Catarina Schiborn, Calogero Saieva, Vittorio Simeon, Claudia Agnoli, Rosario Tumino, Fulvio Ricceri, Leila Luján-Barroso, Maria José Sánchez, Conchi Moreno-Iribas, Konstantinos K. Tsilidis, Marc J. Gunter, Adam Butterworth, Elio Riboli, Heinz Freisling, Pietro Ferrari

Research outputs 2022 to 2026

Our study investigated the association between incident cardiovascular disease (CVD) and subsequent cancer risk in two large European prospective cohorts. We included 568,926 adults from the European Prospective Investigation into Cancer and Nutrition and United Kingdom Biobank, all of whom were free of CVD, cancer and type 2 diabetes at baseline. Multivariable Cox proportional hazards regression models were used to estimate cancer hazard ratios (HRs) and 95% confidence intervals (CIs) in relation to incident CVD events. CVD was treated as a time-varying exposure, and models accounted for time since CVD diagnosis and other lifestyle factors. Study-specific estimates were pooled using …

Underfunded And Undervalued: Community-Based Health Promotion Practitioners’ Experiences Of Western Australia’S Prevention Sector, Ruth M. Wallace, Leesa N. Costello, Elizabeth J. Cook

Research outputs 2022 to 2026

Prevention is a central policy focus of contemporary health promotion, offering cost-effective strategies to reduce disease burden and improve population well-being. Despite this, Australia allocates a small proportion of its health budget to prevention, with funding models characterized by short-term cycles and competitive tendering. While the consequences for public health are well documented, the impact on the health promotion workforce remains underexplored. Workforce health and stability are critical for program delivery, ethical practice, continuity of relationships with communities, and the capacity to sustain long-term prevention efforts. This qualitative study examined the experience of 19 community-based health promotion practitioners in Western …

Understanding Oral Habits And Malocclusion In School-Aged Children: Insights From Parental And Child Knowledge, Attitudes, And Practices, Maria Laurentia Sanjaya, Evan Raditya Pratomo, Markus Santoso, Agrippine Putricia Asaeli, Eveline Yulia Darmadi, Joy Janny Thenarianto, Jennifer Regina Putri Purwono, Eunike Jacquelyn Widarto

Kesmas

Malocclusion is a prevalent oral health problem in children associated with oral bad habits, yet the extent to which parental and child knowledge, attitudes, and practices (KAP) influence orthodontic status remains insufficiently understood. This cross-sectional study investigated relationships between parental and child KAP, oral habits, and malocclusion in school-aged children, involving 67 child–parent pairs from an elementary school in Surabaya, Indonesia. Parental and child KAP as well as child-reported oral habits were assessed using a validated questionnaire. Children subsequently underwent standardized clinical orthodontic examinations, including alginate jaw impressions to produce dental study models, which were evaluated using the Index of …

Spatial Association Of Acute Respiratory Infection, Diarrhea, And Low Birth Weight With Stunting Prevalence In Indonesia, 2024, Dian Rosadi, Husaini Husaini, Triawanti Triawanti, Musafaah Musafaah

Kesmas

Stunting remains unevenly distributed across Indonesia, but national evidence integrating spatial analysis and spatial regression is limited. This study examined the spatial distribution of stunting and its associations with acute respiratory infection (ARI), diarrhea, and low birth weight (LBW) across Indonesian provinces. An ecological cross-sectional study used data from the 2024 Indonesian Nutritional Status Survey. Stunting-only analyses included all 38 provinces, whereas analyses involving ARI, diarrhea, and LBW included 37 provinces with complete data. Spatial analyses used a row-standardized symmetric four-nearest-neighbor spatial weights matrix and included Global Moran’s I, bivariate spatial analysis, Local Indicators of Spatial Association, ordinary least squares, …

The Association Between Rapid Growth In Children Under The Age Of Five And Adolescent Obesity, Ratu Ayu Dewi Sartika, Fadila Wirawan, Iche Andriyani Liberty, Nurul Husna Mohd Shukri, Siti Arifah Pujonarti, Edy Purwanto, Munaya Fauziah

Kesmas

Early-life nutrition is a critical predictor of long-term health, yet the association between rapid early-childhood growth and adolescent obesity, particularly in relation to the “double burden of malnutrition,” remains under-researched in Indonesia. This study aimed to analyze the association between rapid growth and adolescent obesity. Data were obtained from the 1997, 2000, and 2014 waves of the Indonesian Family Life Survey (IFLS). This study included 641 children (aged 0–23 months at baseline) with complete anthropometric measurements across all three waves. Rapid growth was defined as an increase in z-scores of >0.67 in weight-for-age (WAZ), height-for-age (HAZ), or weight-for-height (WHZ) between …

Environmental Perspective For System Dynamics Modeling Of Stunting Mitigation To Achieve The Sustainable Development Goals In West Sumatra, Indonesia, Elsa Yuniarti, Nabila Azzahra, Yulhendri Yulhendri, Heldi Heldi, Mery Delvina, Saskia Putri Azeli

Kesmas

This study developed a system dynamics model to simulate stunting reduction in West Sumatra Province, Indonesia, by integrating infant and toddler health, maternal health, and environmental determinants. Secondary data from 2020–2024 on low birth weight, immunization, malnutrition, exclusive breastfeeding, maternal chronic energy deficiency, iron and folic acid supplement distribution, sanitation, and safe drinking water access were compiled from West Sumatra Provincial Health Office and Statistics Indonesia, and validated through consultation with five stakeholder institutions. Causal Loop Diagrams mapped feedback relationships among determinants and were translated into Stock Flow Diagrams using Powersim Studio 10. The model was validated through structural verification, …