Digital Commons Network^™

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 …

Length And Framing Of Anti-Junk Food Ads Impact Inclinations To Consume Junk Food Among Normal Weight, Overweight, And Adults With Obesity, Ross C. Hollett, Brennen Mills, Stephanie L. Godrich, Julia Butt, Gina S.A. Trapp

Research outputs 2022 to 2026

Background: Unrestricted junk food advertising increases the risk of short-term junk food consumption among viewers. We aimed to estimate the impact of junk food and anti-junk food advertisements differing in length and framing on junk food consumption inclinations. Methods: Adult participants (N = 505) were exposed to a randomly selected junk food advertisement or anti-junk food advertisement and reported their immediate craving and consumption intentions. These responses were separately analysed for two groups based on Body Mass Index (BMI): participants classified as within the normal range (18.5–25), and a combined group with BMI values indicating either overweight (25+) or obesity …

Confessions In Cases Of Child Physical Abuse-A Capnet Study, Margaret R Russell, Antoinette L Laskey, Henry T Puls, Suzanne P Starling, Joanne N Wood, Daniel M Lindberg, Nancy S Harper, Caitlin R Mcnamara, Angela N Bachim, Farah W Brink, Lori D Frasier, James D Anderst, Porcia Vaughn, Kristine A Campbell

Faculty, Staff and Students Publications

Objective: Prior research on confessions of physical abuse (PA) has explored mechanisms of injury. Little is known about conditions supporting a confession of abuse or how confessions may influence case outcomes.

Methods: This cross-sectional study of suspected PA in children aged < 10 years at 10 centers participating in CAPNET, a multicenter child PA research network, included children with in-person Child Abuse Pediatrics (CAP) consultations between February 2021 and December 2022 and excluded children without injury. Our focus was a confession of inflicted injury known to the CAP during clinical involvement. We compared child and clinical characteristics, out-of-home (OOH) placements, and arrests between cases with and without confessions. Multivariable models using generalized estimating equations (GEE) produced adjusted predicted probabilities (APP) clustering by CAPNET site.

Results: Confessions were known to CAPs in 115/4297 (2.7%) cases, with significant site variability. In a multivariable GEE model, confessions were more likely in cases with injuries with high specificity for abuse (APP 6.0% vs 1.6%, P < .001), near-fatality (APP 5.6% vs 2.3%, P < .001), and older children (APP 4.8% vs 2.5%, P = .025). OOH placements and arrests were more common in cases with confessions. CAP awareness of confessions, OOH placements, and arrests did not follow racial or ethnic patterns seen in the US child welfare system. Lower socioeconomic status was associated with OOH placements and arrests but not with CAP awareness of confessions.

Conclusions: Our findings highlight differences in case characteristics and outcomes where a confession is known to the CAP and raise questions about …

Mental Health Literacy Among Perinatal Healthcare Professionals In The United Arab Emirates: A Multiphase Convergent Mixedmethods Study, Rouwida Khalil Elkhalil

Dissertations

Perinatal mental disorders (PNMDs) pose a significant public health concern due to their impact on maternal well-being, infant development, and family functioning. Effective identification and management of PNMDs depend largely on the mental health literacy (MHL) of healthcare professionals, particularly those working in perinatal settings. However, MHL among perinatal healthcare professionals in the United Arab Emirates (UAE) remains underexplored. This dissertation aimed to examine and conceptualize MHL among perinatal healthcare professionals in the UAE, explore factors influencing its application in clinical practice, and inform evidence-based improvements in perinatal mental health care. A multiphase convergent mixed-methods design was employed across four …

Education And Training In Water Operator Certification And Its Role In Water Utility System Performance, Heath A. Edelman

Educational Leadership & Workforce Development Theses & Dissertations

Access to safe and reliable drinking water is a foundational component of public health and environmental protection. The United States drinking water sector is highly regulated and increasingly challenged by workforce shortages, aging infrastructure, and variability in operator training requirements across states. Despite the federal mandate for operator certification under the Safe Drinking Water Act Amendments of 1996, empirical evidence on the effectiveness of certification policies in improving regulatory compliance outcomes remains limited.

This study examined the relationship between operator certification policies and drinking water compliance outcomes under the Safe Drinking Water Act, with particular attention to differences across violation …

Lessons Learned From The Implementation Of A Pragmatic Trial Evaluating Non-Pharmacological Approaches To Dementia Care In Us Nursing Homes, Carin Wong, Catherine V. Piersol, Felicia Chew, Cara Lekovitch, Victoria Shier, Mike Morris, Jenny Martínez, Julie Britton, Natalie E. Leland

Department of Occupational Therapy Faculty Papers

RATIONALE: The consistent delivery of effective evidence into nursing home practice has been shown to enhance quality of care and residents' outcomes. Pragmatic trials enable the evaluation of efficacious interventions in a real-world context, including care of residents living with Alzheimer's Disease and Related Dementias (ADRD). Yet, there are limited pragmatic trials conducted in nursing homes and even less evidence on the strategies to successfully conduct such research in this setting.

OBJECTIVE: To identify the lessons learned from a pragmatic trial and provide recommendations for future successful studies in United States (US) nursing homes.

METHODS: Drawing on a case example …

Daily Outdoor Pm2.5 Exposure Characterization And Road Edge Effect During A 2022 - 2023 Monitoring Campaign In Gambia, Kenya And Mozambique, Terence Mushore, Handsome Nyoni, Laura Munthali, Sibusisiwe Makhanya, Laurine Chikoko, Anotida Chapunza, Stanley Luchters, Matthew Chersich, Marleen Temmerman, Angela Koech

Centre of Excellence in Women and Child Health

Air pollution is a major contributor to mortality and adverse health outcomes, particularly in pregnant women and children, with vehicular emissions as a key source. This study aimed to characterize long-term exposure to fine particulate matter (PM2.5), evaluate potential health risks, and quantify the contribution of road transport and proximity to roads in The Gambia, Kenya, and Mozambique. Multi-temporal personal exposure data were interpolated into continuous spatial surfaces and aggregated into daily averages, which were then compared with World Health Organization (WHO) guidelines to assess potential health impacts. Multi-distance buffers at 10 m intervals up to 1000m from major roads …

Yield Of Injury Testing For Contacts Of Children Evaluated For Physical Abuse, Lígia Batista, Joanne N Wood, Tagrid M Ruiz-Maldonado, M Katherine Henry, Jan Leonard, Angela Bachim, James D Anderst, Farah W Brink, Hannah B Sahud, Lori D Frasier, Nancy S Harper, Natalie Laub, Colleen J Bressler, Daniel M Lindberg

Faculty, Staff and Students Publications

Background: Siblings and household contacts of physically abused children are at increased risk for physical abuse and may have injuries that are not clinically apparent. However, injury testing recommendations for contact children remain debated.

Objective: Our objective was to describe testing practices and yield for contacts of physically abused children.

Participants and settings: This is a cross-sectional study of children < 10 years old evaluated for physical abuse at 10 US pediatric referral centers in the CAPNET research network.

Methods: We report the proportion of contact children who had a skeletal survey (SS) or neuroimaging and describe the proportion of tests that identified injuries.

Results: Among 6256 index evaluations, 4863 contacts were identified. Among 794 contacts with physical examinations, …

“Recollecting The Told Story”: Storytelling, Activism, And The Black Maternal Health Emergency, Lamaya C. Williams

English Theses & Dissertations

Storytelling is a foundational component of Black knowledge creation and transmission. This dissertation centers Black women’s stories of birth and mothering—drawing on both primary source birth stories and fictional narratives—to examine the United States’ Black Maternal Health Emergency (BMHE). The BMHE is a complex and urgent issue wherein structural racism, medical bias, and intersecting social determinants disproportionately endanger the health of Black mothers. As such, Black mothers in the United States are three times more likely to die from a pregnancy-related condition compared to their white counterparts.

This study examines the birth stories of women who survived the BMHE and …

Caregiver Challenges And Health Access For Individuals With Developmental Disabilities In Mississippi, Kirsten Cunningham

Honors Theses

Current literature has highlighted the health disparities faced by individuals within the disability community and how it affects the care they receive. However, for many individuals with developmental disabilities, they require caregivers to make medical decisions for them. The purpose of this study is to focus on the caregiver’s perspective of caregiver stress, physical access to care, and health literacy to combat the challenges faced when getting access to healthcare resources for individuals with developmental disabilities in Mississippi. The researcher hypothesized, based on the literature review, that caregivers with higher levels of educational attainment would have less caregiver stress, more …

Application Of The Multi-Theory Model To Determine Predictors Of Initiating And Sustaining Stress Management Behaviors In Undergraduate College Students, Bishoy T. Samuel, Joshua Mann, Michael Welsch, Manoj Sharma, Vinayak K. Nahar

Journal of Public Health in the Deep South

Background: Undergraduate college students face stress and concomitant mental health issues that can be mitigated by proper stress management behavior.

Purpose: This article examines the multi-theory model (MTM) of health behavior as a predictor of change in the primary outcomes of initiation and sustenance of relaxation-seeking behavior in undergraduate college students for the purposes of stress mitigation. The two main research hypotheses tested were that (a) participatory dialogue, behavioral confidence, and change in physical environment have statistically significant effects on initiation of behavioral change, and (b) emotional transformation, practice for change, and change in social environment have statistically significant effects …

Farmers Markets And Produce Purchasing Behaviors Among University Faculty And Staff, Kritika Gupta, Laurel Lambert, Jangwoo Jo, Selby Rebecca Entrekin, Georgianna Mann

Journal of Public Health in the Deep South

Background: This study explores produce purchasing criteria (PPC) and produce purchasing frequency (PPF) among university faculty and staff, a population often underrepresented in dietary behavior research.

Purpose: To identify distinct PPC profiles among university faculty and staff and examine how these profiles are associated with PPF and farmers market usage, while also assessing the role of demographic and behavioral factors in shaping these relationships.

Methods: Using a 29-item online survey administered to faculty and staff at a southern United States university (N = 175), three distinct PPC clusters were identified: health/label conscious, utilitarian, and no-specified-criteria consumers. Statistical analyses — including …

Telemedicine Kiosks: Can Technology Solve Rural Mississippi's Healthcare Crisis?, Babu George, Martha Ravola

Journal of Public Health in the Deep South

Background: Mississippi’s rural counties face hospital gaps, clinician shortages, and limited broadband/device access that collectively delay care and constrain telehealth uptake.

Purpose: This paper assesses whether telemedicine kiosks can improve rural healthcare access in Mississippi while also supporting viable local entrepreneurship and community development.

Methods: A conceptual, policy-and-market analysis integrated narrative literature synthesis, secondary data and policy review, and 5-year financial modeling under two cost-allocation scenarios: an Operator Model (subscription fees covered by partners/grants) and a Network Model (subscription fees borne by the kiosk operator).

Results: Kiosks with embedded connectivity and diagnostic peripherals can deliver device-independent virtual care and directly …

Promoting A Culture Of Academic Integrity In The Context Of Artificial Intelligence: Lessons From One School Of Public Health In The Southeast, Gregory Pavela, Lindsay C. Aycock, Mercy Aula, Angela Sullivan, Matthew Fifolt

Journal of Public Health in the Deep South

No abstract provided.

Aircraft Wastewater Surveillance As A Tool For Monitoring Disease In The Pacific, Carla J. Eaton, Joanne R. Chapman, Brent J. Gilpin

Pacific Journal of Health

Wastewater surveillance is a powerful tool for monitoring infectious diseases within a population. However, as most wastewater surveillance relies on interconnected wastewater networks to provide samples representative of the population, many Pacific Islands have been excluded from benefiting from this tool due to their lack of reticulated sewerage systems. Many diseases of concern for the Pacific are detectable in wastewater even though individuals may be asymptomatic. We investigated whether analysis of wastewater from aircraft arriving in New Zealand from Pacific Island nations could be used as a proxy for in-country surveillance. Flights from the Pacific arrive in Auckland daily, with …

Analisis Disparitas Geospasial Dan Determinan Sosio-Demografis Masalah Kesehatan Jiwa Di Indonesia: Analisis Data Survei Kesehatan Indonesia (Ski) 2023, Alya Zahrah Zhafirah, Sutanto Priyo Priyo Hastono

Jurnal Biostatistik, Kependudukan, dan Informatika Kesehatan

Kesehatan jiwa merupakan pilar utama pembangunan sumber daya manusia yang kini menjadi tantangan struktural di Indonesia. Masalah ini dipengaruhi secara signifikan oleh determinan sosio-demografi seperti tingkat pendidikan, status ekonomi dan lingkungan. Penelitian ini diinisiasi oleh urgensi untuk memetakan distribusi beban masalah kesehatan jiwa secara nasional sekaligus menginvestigasi ketidakonsistenan prevalensi antara data Riskesdas 2018 dan SKI 2023. Penelitian ini menggunakan desain potong lintang dengan menganalisis prevalensi masalah kesehatan jiwa pada penduduk Indonesia berusia ≥15 tahun, menggunakan data SKI 2023. Kondisi kesehatan jiwa dinilai menggunakan instrumen SRQ-20 untuk mengidentifikasi probabilitas masalah kesehatan jiwa. Hasil utama menunjukkan prevalensi masalah kesehatan jiwa Indonesia tahun …

Characteristics Of Leprosy Chemoprophylaxis Recipeints In The Tirtayasa Public Health Center Area, 2023–2024, Rifa Imaroh, Maria Angela Lumaksono, Izzah Imani, Dhelya Widasmara

Jurnal Epidemiologi Kesehatan Indonesia

Leprosy remains a public health problem in Indonesia. In 2023, Indonesia ranked third globally in the number of leprosy cases, with 14,376 reported cases, after India (107,851 cases) and Brazil (22,773 cases). One of the key strategies for leprosy control in Indonesia is the implementation of preventive measures, including home visits and the administration of chemoprophylaxis using single-dose rifampicin (SDR). Post-exposure prophylaxis plays an important role in preventing leprosy transmission among contacts of confirmed patients. This study aimed to describe the characteristics of leprosy chemoprophylaxis recipients in the Tirtayasa Public Health Center area during 2023–2024. This study was an descriptive …

Risk Factors Of Leptospirosis Among Agricultural Workers In Southeast Asia: Literature Review, Ronggo Adi Wibowo, Wawa Najwa Nurzakia, Meirany Sasitha Kirana, Yulia Arthemisia Wijaya, Jasmine Ayumaharani Sekaryudha, Dwi Sarwani Sri Rejeki, Rosita Dwi Jayanti

Jurnal Epidemiologi Kesehatan Indonesia

The agricultural sector is the primary source of livelihood for communities in Southeast Asia; however, these activities increase the risk of exposure to zoonotic diseases, particularly leptospirosis. Southeast Asia is one of the regions with the highest incidence of leptospirosis in the world. This literature review aims to identify risk factors for leptospirosis among agricultural workers in Southeast Asia. The search for research articles utilized three databases (Google Scholar, PubMed, and ScienceDirect) using a descriptive approach based on literature review and the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. A total of 9,800 articles were screened for …

Factors Associated With Stunting Among Children Aged 6 – 59 Months Attending Integrated Health Post (Posyandu) In Selapajang And Kedaung Wetan Villages, Neglasari Sub-District, Tangerang City: A Matched Case-Control Study, Michael Alexander Solang, Joue Abraham Trixie, Gloria Semula, Tiona Simamora, Conny Tanjung

Jurnal Epidemiologi Kesehatan Indonesia

Stunting is a problem in Indonesia. In 2022, Kedaung Wetan and Selapajang Villages in Neglasari sub-district, Tangerang City, were identified as a priority. This study aimed to identify factors associated with stunting among children (6 – 59 months) in these villages. A matched case-control study consisting of 214 children (107 cases and 107 controls) was conducted, with individual matching based on age, sex, and prematurity at birth. Cases were children with height-for-age (H/A) measurement less than -2SD (according to WHO standard), while controls were children with H/A equal to or greater than -2SD. Conditional logistic regression was used for the …

Incidence Of Carpal Tunnel Syndrome After The Diagnosis Of Ulnar Neuropathy, Harrison S. Fellheimer, Eric Didomenico, Mahaa Ayub, Magnolia Livingston, William L. Justice, Gabriel I. Onor, Eric Tecce, Pedro K. Beredjiklian

Department of Orthopaedic Surgery Faculty Papers

PURPOSE: The purpose of this study is to determine whether patients diagnosed with ulnar nerve lesions (UNLs) have an increased risk of developing carpal tunnel syndrome (CTS).

METHODS: A retrospective cohort study was conducted using the TriNetX database, which contains data of >100 million patients. We identified 360,021 patients with UNLs and matched them 1:1 with controls. The incidence of CTS was assessed at 1, 2, 3, 4, and 5 years following the diagnosis of UNL. Statistical analyses were used to evaluate the development of CTS in the UNL cohort compared with controls.

RESULTS:  Patients with UNL demonstrated a significantly …

Impact Of Tropical Cyclones On Food And Nutrition Security: A Global Scoping Review And Thematic Analysis, Patience M. Chiotha, Budi Haryanto

Jurnal Epidemiologi Kesehatan Indonesia

The increasing frequency and intensity of tropical cyclones driven by climate change pose growing threats to food and nutrition security. Globally, an estimated 80–90 tropical cyclones occur annually, affecting approximately 119 million people. Evidence regarding their impact on food systems, dietary patterns, and nutritional status remains fragmented. This scoping review aimed to map global evidence on the impacts of tropical cyclones on food and nutrition security, identify key pathways of impact, and examine affected indicators at household and individual levels. The review followed Joanna Briggs Institute guidelines and PRISMA-ScR. Searches were conducted in PubMed/MEDLINE, Web of Science, Scopus, and Google …

The Effects Of Ultra-Processed Food Consumption On Cancer Development, Bailey G. Ottmann

Emerging Writers

The dramatic rise in ultra-processed food (UPF) consumption worldwide has sparked growing concerns about its impact on cancer development and human health. UPFs contain high levels of added sugars, unhealthy fats, chemical additives, dyes, and toxic compounds formed during cooking and processing. This study investigates the relationship between UPF consumption and cancer through a review of primary and secondary sources, alongside an observational survey conducted among 15 healthcare professionals, including physicians, nurses, and nursing educators. Survey findings indicate that 53% of participants observed higher cancer prevalence in patients consuming large amounts of UPFs, with colorectal cancer most frequently reported. The …

Determinants Of Stunting Among Under-Five Children (0–59 Months) In Central Sulawesi Province, Marchell Bamba, Mondastri Korib Sudaryo, Ratna Djuwita, Helwiah Umniyati

Jurnal Epidemiologi Kesehatan Indonesia

Stunting is caused by chronic malnutrition which can be caused by various factors including poverty, poor nutritional intake and maternal health, and inappropriate infant feeding. This study was conducted to determine what factors cause stunting in Central Sulawesi Province. This study was conducted using a cross-sectional observational analysis method using secondary data from the Survei Kesehatan Indonesia (SKI) 2023. The analysis was carried out using logistic regression. The sample used was 2179 respondents. The dependent variable is stunting while the independent variables are age, gender, area of residence, gestational age, provision of PMT, exclusive breastfeeding, maternal occupation, maternal education, and …

The Relationship Between Smartphone Screen Time Duration And Individual Chronotype: A Systematic Literature Review, Diego Sergio Giasia Lumbantobing, Thalia Altamilano Pramudya

Jurnal Epidemiologi Kesehatan Indonesia

The rapid increase in smartphone use over the past decade led to prolonged screen time across age groups, particularly during nighttime hours. Exposure to artificial light and pre-sleep digital activities was associated with circadian rhythm disruption and alterations in individual chronotype. This systematic literature review aimed to synthesize empirical evidence on the relationship between smartphone screen time duration and individual chronotype across all age groups and to identify key moderating factors influencing this association. The review was conducted in accordance with PRISMA 2020 guidelines. Literature searches were performed in PubMed, Scopus, and ScienceDirect for studies published between 2015 and 2025. …

Examining Predictors For Surgical Site Infection Following Abdominal Hysterectomy Among Women In New York, Nicole Henry

Walden Dissertations and Doctoral Studies

Surgical site infections (SSIs) remain one of the most frequent and preventable complications following abdominal hysterectomy. Existing literature has focused on clinical and procedural risk factors, while less is known about how social conditions shape surgical outcomes. This gap is especially concerning for women in New York State (NYS) where differences in income, marital status, primary payer, rurality, and county-level food insecurity may influence postoperative outcomes and subsequent care. The socioecological model provided the foundation for this retrospective cohort study by examining how social drivers of health (SDoH) are associated with SSI incidence following abdominal hysterectomy, and whether food insecurity …

U.S. Pharmacists’ Perceptions Of Getting The Covid-19 Vaccine And How That Affects Their Interactions With The Public, Megan Boals

Walden Dissertations and Doctoral Studies

Pharmacists play a pivotal role in public health, particularly in promoting vaccination. However, vaccine hesitancy among pharmacists significantly undermines their willingness to provide effective patient counseling and to advocate for vaccination, potentially eroding public trust in vaccines. This descriptive-phenomenological study sought to understand the factors contributing to pharmacists’ COVID-19 vaccine hesitancy and how this hesitancy affected their willingness to recommend vaccines to patients. Twenty practicing pharmacists were interviewed via Zoom between September 23 and October 14, 2025. The health belief model helped interpret the study findings. Thematic analysis, as described by Braun and Clarke, was conducted to identify and interpret …

The Blurred Boundaries Of Care: A Qualitative Analysis Of Nurse-Doula Role Conflict, Curisa Mae Tucker Phd, Rn, Maria Mcclam, Kelly Russin Dnp, Rnc-Ob, Chse, Nansi Boghossian, Rachel Gulczinski, Lauren Workman

Faculty Publications

Introduction:

Methods:

Patterns Of Multimorbidity Among Low-Income Adults Who Smoke With Implications For Tailored Interventions: A Cluster Analysis Using A Mixture Of Bernoulli Model, Monique T. Cano, Michael R. Lindstrom, Oscar F. Rojas Perez, Ricardo F. Muñoz

School of Mathematical & Statistical Sciences Faculty Publications

Introduction: Smoking cigarettes remains a leading modifiable risk factor for preventable health conditions. In the United States, the health burden of smoking disproportionately impacts low-income individuals. Multimorbidity is common in this group, complicating treatment and worsening outcomes. Identifying multimorbidity clusters can support targeted, individualized interventions. This study aimed to identify multimorbidity clusters among individuals who smoke and experience economic hardship and provide clinical recommendations to enhance health outcomes.

Method: Individuals who smoke and experience economic hardship (N = 60) were recruited from the San Francisco Health Network (SFHN) and were assessed for physical and mental conditions. Cluster analysis was …

Prevalence And Determinant Factors Of Depression Among Pregnant Women In Poned Health Center In Tangerang City Area, Dian Geumala Hayati, Sudijanto Kamso, Popy Yuniar, Yuli Puspita Devi

Jurnal Epidemiologi Kesehatan Indonesia

According to World Health Organization (WHO), approximately 10% of pregnant women experience mental disorders, with depression being particularly prevalent. In developing countries, this rate is was even higher, reaching 19.8% after childbirth and 15.6% during pregnancy. Various studies conducted in Indonesia show that the prevalence of depression among pregnant women ranges widely, from 21.4% to 26.2%.This study aimed to determine the prevalence and risk factors associated with depression during pregnancy in pregnant women at the PONED Community Health Center in Tangerang City Area. A facility-based cross-sectional study was conducted with 105 pregnant women attending antenatal check-ups at the 17 PONED …

Association Between The Dietary Index For Gut Microbiota (Di-Gm) And Colorectal Cancer In The Plco Cohort, Bezawit E. Kase, Angela D. Liese Ph.D., Jiajia Zhang Ph.D., Elizabeth Angela Murphy, Susan E. Steck Phd, Mph, Rd

Faculty Publications

Objectives: The study aimed to examine the association between a dietary index for gut microbiota (DI-GM) and the risk of incident colorectal cancer (CRC). Clarifying the role of diet-induced alterations in the composition and function of gut microbiota on the development of CRC can contribute to prevention efforts. Methods: Participants from the Prostate, Lung, Colorectal, and Ovarian Cancer Screening trial enrolled in the intervention arm and who completed baseline assessments were included in the analysis (n = 55,685). The DI-GM is a literature-derived index used to score diet quality in terms of maintaining healthy gut microbiota. A time-dependent Cox model …