Digital Commons Network^™

Temporal Geospatial Analysis Of Covid-19 Pre-Infection Determinants Of Risk In South Carolina, Tianchu Lyu, Nicole L. Hair, Nicholas Yell, Zhenlong Li, Shan Qiao, Chen Liang, Xiaoming Li

Faculty Publications

Disparities and their geospatial patterns exist in morbidity and mortality of COVID-19 patients. When it comes to the infection rate, there is a dearth of research with respect to the disparity structure, its geospatial characteristics, and the pre-infection determinants of risk (PIDRs). This work aimed to assess the temporal–geospatial associations between PIDRs and COVID-19 infection at the county level in South Carolina. We used the spatial error model (SEM), spatial lag model (SLM), and conditional autoregressive model (CAR) as global models and the geographically weighted regression model (GWR) as a local model. The data were retrieved from multiple sources including …

Small Studies, Big Decisions: The Role Of Pilot/Feasibility Studies In Incremental Science And Premature Scale-Up Of Behavioral Interventions, Michael William Beets, Lauren Von Klinggraeff, Robert G. Weaver, Bridget Ryan Armstrong, Sarah Burkart

Faculty Publications

Background: Careful consideration and planning are required to establish “sufficient” evidence to ensure an investment in a larger, more well-powered behavioral intervention trial is worthwhile. In the behavioral sciences, this process typically occurs where smaller-scale studies inform larger-scale trials. Believing that one can do the same things and expect the same outcomes in a larger-scale trial that were done in a smaller-scale preliminary study (i.e., pilot/feasibility) is wishful thinking, yet common practice. Starting small makes sense, but small studies come with big decisions that can influence the usefulness of the evidence designed to inform decisions about moving forward with a …

Functions Of Social Networks In Maternal Food Choice For Children In Mexico, Ligia I. Reyes, Edward A. Frongillo, Spencer Moore, Christine E. Blake, Wendy Gonzalez, Anabelle Bonvecchio

Faculty Publications

Food choice for children has important implications in establishing early-life dietary habits and preferences. Food choice for children has been studied as parent–child dyad dynamics, but little is known about the extended system of relationships in maternal food choice for children. The objective of this study was to understand the functions of mothers' social networks in the food choices that mothers make for their children ages 1 to 5 years old in rural Mexico. In-depth interviews were conducted with 46 participants in three rural communities. The interviews inquired about participants' child-feeding practices, personal and local beliefs about child feeding and …

Maternal Resources For Care Are Associated With Child Growth And Early Childhood Development In Bangladesh And Vietnam, Sulochana Basnet, Edward A. Frongillo Jr., Phuong Hong Nguyen, Spencer Moore, Mandana Arabi

Faculty Publications

BACKGROUND:

Suboptimal child growth and development are significant problems in low- and middle-income countries. Maternal resources for care may help to improve growth and development. This study examined the association of maternal resources for care on child length, motor development and language development of children 12-23.9 months old.

METHODS:

We used baseline data from the Alive & Thrive household surveys collected in Bangladesh (n = 803) and Vietnam (n = 635). Resources for care were represented by maternal education, knowledge, height, well-nourishment, mental well-being, decision-making, employment, support in chores and perceived support. The regression analyses were adjusted for household wealth …

Concurrent Associations Between Expressive Language Ability And Independence In Adolescents And Adults With Fragile X Syndrome, Leonard Abbeduto, Jessica Klusek, Julie Lounds Taylor, Nadia Abdelnur, Nicole Sparapani, Angela John Thurman

Faculty Publications

BACKGROUND: Few individuals with fragile X syndrome (FXS) successfully meet adult normative expectations in education, employment, peer relations, and habitation, although there is within-syndrome variability in this regard. The primary goal of this study was to determine whether expressive language skills contribute to the capacity for independent functioning in adulthood even after controlling for nonverbal cognitive ability. METHODS: Participants were 18- to 23-year-olds with FXS. Expressive language was assessed using the psychometrically validated Expressive Language Sampling (ELS) conversation and narration procedures. The language produced was transcribed and analyzed to yield measures of expressive vocabulary, syntax, and intelligibility. Parents concurrently completed …

The Power Of Tolerance Vs. Unselfishness As A Cultural Determinant Of Cooperation, Kimmo Eriksson, Brent Simpson, Irina Vartanova

Faculty Publications

Cooperation in collective action problems and resource dilemmas is often assumed to depend on the values of the individuals involved, such as their degree of unselfishness and tolerance. Societal differences in cooperation and cooperative norms may therefore result from cultural variation in emphasis on these personal values. Here we draw on several cross-national datasets to examine whether society-level emphasis on unselfishness and tolerance and respect for other people predict how societies vary in cooperation [in a continuous prisoner’s dilemma (PD)] and in norms governing cooperation [in a common pool resource dilemma (CPR)]. The results suggest that high levels of cooperation …

Examining Associations Between Knowledge And Vaccine Uptake Using The Human Papillomavirus Knowledge Questionnaire (Hpv-Kq), Sayward Harrison, Valerie Yelverton, Yunfei Wang, Jan Ostermann, Laura J. Fish, Charnetta L. Williams, Lavanya Vasudevan, Emmanuel B. Walter

Faculty Publications

Objectives: Understanding the relationship between human papillomavirus (HPV) knowledge and vaccination behavior is important to inform public health interventions, yet few validated HPV knowledge scales exist. This study describes development of the Human Papillomavirus Knowledge Questionnaire (HPV-KQ) and its validation with parents residing in the southern United States (US). Methods: Drawing on previously published measures, we developed the 13-item HPV-KQ and administered the scale via Web-based survey to parents (N=1105) of adolescents ages 9 to 17 years. Dimensionality, internal consistency, model fit, and predictive validity were assessed. Results: The scale was bidimensional. One factor captured general HPV knowledge, and the …

Examining Associations Between Knowledge And Vaccine Uptake Using The Human Papillomavirus Knowledge Questionnaire (Hpv-Kq), Sayward Harrison, Valerie Yelverton, Jan Ostermann Ph.D., Laura J. Fish, Charnetta L. Williams, Lavanya Vasudevan, Emmanuel B. Walter

Faculty Publications

Objectives: Understanding the relationship between human papillomavirus (HPV) knowledge and vaccination behavior is important to inform public health interventions, yet few validated HPV knowledge scales exist. This study describes development of the Human Papillomavirus Knowledge Questionnaire (HPV-KQ) and its validation with parents residing in the southern United States (US). Methods: Drawing on previously published measures, we developed the 13-item HPV-KQ and administered the scale via Web-based survey to parents (N=1105) of adolescents ages 9 to 17 years. Dimensionality, internal consistency, model fit, and predictive validity were assessed. Results: The scale was bidimensional. One factor captured general HPV knowledge, and the …

Organic Cotton Clothing Purchase Behavior: A Comparative Study Of Consumers In The United States And Bangladesh, Md Nakib Ul Hasan, Chuanlan Liu, Bulbul Ahmed

Faculty Publications

The purpose of this research was to evaluate the differences and similarities of organic cotton clothing (OCC) purchase behaviors of the consumers who lie at the top and the bottom of the apparel supply chain. The influences of consumers’ sustainability knowledge and social norms on consumers’ attitudes and purchase intentions were examined to understand within the framework of the Theory of Reasoned Action (TRA). Sample data were collected from the United States and Bangladesh and, finally, 136 useable responses were used for the data analysis. Among the useable responses, 85 samples were from the US (containing 91.76% female participants and …

Eye Movement Desensitization And Reprocessing (Emdr) Practitioners’ Beliefs About Memory, Sanne T.L. Houben, Henry Otgaar, Jeffrey Roelofs, Ineke Wessel, Lawrence Patihis, Harald Merckelbach

Faculty Publications

Eye movement desensitization and reprocessing (EMDR) is a widely used treatment for posttraumatic stress disorder. The idea behind EMDR is that lateral eye movements may mitigate the emotional impact of traumatic memories. Given the focus on changing patients’ memories, it is important that EMDR practitioners have detailed knowledge about human memory. We explored beliefs and ideas about memory in samples of EMDR practitioners (Study 1: n = 12; Study 2: n = 41), students (Study 1: n =35; Study 2: n = 24), and researchers (Study 2: n = 30). All groups seemed to be aware of the fallibility of …

Multilevel Modeling Of Interval-Contingent Data In Neuropsychology Research Using The Imertest Package In R, Richard S. Pond Jr., Matison W. Mccool, Brian A. Bulla

Faculty Publications

Intensive longitudinal research designs are becoming more common in the field of neuropsychology. They are a powerful approach to studying development and change in naturally occurring phenomena. However, to fully capitalize on the wealth of data yielded by these designs, researchers have to understand the nature of multilevel data structures. The purpose of the present article is to describe some of the basic concepts and techniques involved in modeling multilevel data structures. In addition, this article serves as a step-by-step tutorial to demonstrate how neuropsychologists can implement basic multilevel modeling techniques with real data and the R package, lmerTest. R …

Setting The Research Agenda For Nursing Administration And Leadership Science: A Delphi Study, Esther Maria Chipps, M Lindell Joseph, Catherine Alexander, Bret Lyman, Logan Mcginty, Heather Nelson-Brantley, Joy Parchment, Reynaldo R. Rivera, Mary Anne Schultz, Danielle M. Ward, Susan Weaver

Faculty Publications

Objective: The aim of this study was to identify and prioritize research topics for nursing administration and leadership science.

Background: Nursing administration and leadership research priorities should provide a framework for building the science needed to inform practice.

Methods: The Association for Leadership Science in Nursing (ALSN) and American Organization for Nursing Leadership (AONL) Foundation (AONL-F) for Nursing Leadership and Education collaborated on a Delphi study. Initial input on research priority items were received from ALSN and AONL members. National experts participated in a 3-round Delphi study.

Results: Top-ranked priorities included: 1) nurses' health, well-being, resiliency, and safety in the …

Organizational Learning During Covid-19: A Qualitative Study Of Nurses' Experiences, Bret Lyman, Morgan K. Horton, Alyssa Oman

Faculty Publications

Aim: The aim of this study is to test the validity of the Organizational Learning in Hospitals model in the context of the COVID-19 pandemic.

Background: Organizational learning is especially crucial in circumstances of intense, complex, enduring change, as with the COVID-19 pandemic. Nurse managers need additional guidance for fostering organizational learning under such circumstances. The Organizational Learning in Hospitals model may be a helpful resource but requires additional validation.

Methods: Semi-structured interviews were conducted to gather 19 nurses' first-hand experiences of organizational learning during the COVID-19 pandemic. Data were analysed using deductive thematic analysis.

Results: Nurses' experiences of organizational …

What Factors Influence Hiv Testing? Modeling Preference Heterogeneity Using Latent Classes And Class-Independent Random Effects, Jan Ostermann Ph.D., Brian P. Flaherty, Derek S. Brown, Bernard Njau, Amy M. Hobbie, Tara B. Mtuy, Max Masnick, Axel C. Mühlbacher, Nathan M. Thielman

Faculty Publications

Efforts to eliminate the HIV epidemic will require increased HIV testing rates among high-risk populations. To inform the design of HIV testing interventions, a discrete choice experiment (DCE) with six policy-relevant attributes of HIV testing options elicited the testing preferences of 300 female barworkers and 440 male Kilimanjaro mountain porters in northern Tanzania. Surveys were administered between September 2017 and July 2018. Participants were asked to complete 12 choice tasks, each involving first- and second-best choices from 3 testing options. DCE responses were analyzed using a random effects latent class logit (RELCL) model, in which the latent classes summarize common …

Financial Behaviors, Financial Satisfaction, And Goal Attainment Among College-Educated Young Adults: A Mediating Analysis With Latent Change Scores, Xiaomin Li, Melissa Curran, Joyce Serido, Ashley B. Lebaron, Soyeon Shim, Nan Zhou

Faculty Publications

The aim of the study is to investigate how 2,084 U.S. college-educated young adults (61.9% female, and 69.5% non-Hispanic White) navigated the goal attainment process during the transition to adulthood. Using four-wave data collected across eight years, we examined how financial behaviors (self-regulating behaviors) predicted both depressive symptoms (affective goal attainment evaluations) and financial obstacles to goal attainment (cognitive goal attainment evaluations) via financial satisfaction (resources). Given the variability in developmental trajectories (i.e., initial levels and rates of over-time changes) among young adults, we conducted an exploratory mediational analysis with Latent Change Scores. The results revealed indirect-only mediation patterns, and …

Cheating For The Cause: The Effects Of Performance-Based Pay On Socially Oriented Misreporting, Jessen L. Hobson, Ryan D. Sommerfeldt, Laura W. Wang

Faculty Publications

We examine the effect of performance-based pay on misreporting intended to benefit a social mission. We show that performance-based pay decreases people’s propensity to misreport for a social mission in a not-for-profit setting (Experiment 1). We similarly show that in a for-profit setting, performance-based pay also decreases misreporting propensity for a social mission, although not for a non-social mission (Experiment 2). Finally, using a framed field experiment with participants attending a conference hosted by a real charity, we show that performance-based pay reduces actual misreporting when misreporting leads to more donations for the charity (Experiment 3). These results are consistent …

Family Resilience: Being Refined By The Fire, Alina M. Baltazar

Faculty Publications

No abstract provided.

Bidirectional Relationships Among Children’S Perceived Competence, Motor Skill Competence, Physical Activity, An Cardiorespiratory Fitness Across One School Year, Suryeon Ryu, Jung Eun Lee, Nan Zeng, David F. Stodden, Daniel J. Mcdonough, Wenxi Liu, Zan Gao

Faculty Publications

Purpose. The bidirectional associations among children’s motor skill competence (MSC), perceived competence (PC), physical activity (PA), and cardiorespiratory fitness (CRF) over time remain unanswered. This study is aimed at discerning the bidirectional relationships among elementary school children’s MSC, PC, PA and, CRF over the course of one school year. Methods. A total of 261 second and third grade children (127 boys, 134 girls; mean_age = 8.27 years; BMI = 18.22 ± 3.71) were recruited from two Texas elementary schools. Approximately 73.56% of participants were White American. Children’s baseline data were assessed in September/October in 2012 (Time1), and …

On The Anguish Of Going: An Actor’S Endgame, Jennifer Cavenaugh

Faculty Publications

Sometimes a theatrical production comes along that illuminates a familiar text, bringing parts of the story into a new focus or revealing other parts hitherto unseen. The Endgame Project, conceived by veteran New York actors Dan Moran and John Christopher Jones, is one of these productions. In this conception of Samuel Beckett’s Endgame, Clov and Hamm, two characters with diminishing physical abilities, are played by Jones and Moran, two seasoned actors who are both living with Parkinson’s disease. The Endgame Project creates a powerful joining of Beckett’s script and the Parkinson’s disease that holds the principal actors in its …

Assessing Oral Language When Screening Multilingual Children For Learning Disabilities In Reading, J. Marc Goodrich, Lisa A. Fitton Ph.D., Jessica Chan, C. Jamie Davis

Faculty Publications

Multilingual children represent a rapidly growing population of students in U.S. schools. However, identification of language and learning disabilities for students from different linguistic backgrounds is complex, leading to frequent misidentification of multilingual learners for special education. This article provides guidance on how special education teachers, speech-language pathologists, and other practitioners (e.g., school psychologists) can utilize each other’s expertise to accurately assess language and literacy skills of multilingual learners. Five key lessons learned from research on identification of language disorders are presented, along with discussion of why these are important when screening multilingual children for learning disabilities in reading. Specifically, …

Suicide Attempts In Us Veterans With Chronic Headache Disorders: A 10-Year Retrospective Cohort Study, X. Michelle Androulakis, Siyuan Guo, Jiajia Zhang Ph.D., Jason Sico, Peter Warren, Alec Giakas, Xiaoming Li Ph.D., B Lee Peterlin, Roy Mathew, Deborah Reyes

Faculty Publications

Objectives: A large-scale retrospective analysis of veterans with chronic pain was con-ducted to examine (1) the annual incidence of suicide attempts (SA) in veterans with chronic headache and other chronic pain conditions, and (2) the risk of SA in men and women with chronic headache and chronic headache concurrent with traumatic brain injury (TBI) as compared to non-headache chronic pain.

Methods: This retrospective study (N=3,247,621) analyzed National Veterans Affair Health Administrative data of patients diagnosed with chronic head, neck, back and other chronic pain from 2000 to 2010. Multivariable Poisson regression was used to explore the relative risks of SA …

Relationship Form And Function: Exploring Meaning-Making In Young Adults' Romantic Histories, Tyler B. Jamison, Caroline M. Sanner

Faculty Publications

Forming stable, supportive romantic relationships is an important determinant of well-being for adults. Yet, there has been limited research about if and how prior romantic experiences help individuals develop the capacity to enter into such unions. Using grounded theory methods, relationship history interviews were conducted with 35 young adults who provided data about 256 romantic and sexual relationships. The different relationship forms (e.g., hooking up, casual dating, committed partnering) were found to contribute in nuanced ways to romantic development. Specifically, romantic development was characterized by gaining romantic experience, identifying preferences for partners and partnership, and learning to maintain healthy relational …

‘Access Necessitates Being Seen’: Queer Visibility And Intersectional Embodiment Within The Health Information Practices Of Queer Community Leaders, Travis L. Wagner, Vanessa Kitzie

Faculty Publications

Navigating healthcare infrastructures is particularly challenging for queer-identifying individuals, with significant barriers emerging around stigma and practitioner ignorance. Further intersecting, historically marginalised identities such as one’s race, age or ability exacerbate such engagement with healthcare, particularly the access to and use of reliable and appropriate health information. We explore the salience of one’s queer identity relative to other embodied identities when navigating health information and care for themselves and their communities. Thirty semi-structured interviews with queer community leaders from South Carolina inform our discussion of the role one’s queer visibility plays relational to the visibility of other identities. We find …

Covid-19 Influences On Us Recreational Angler Behavior, Stephen R. Midway, Fraser Andrew Januchowski-Hartley, Abigail J. Lynch, Brandon K. Peoples, Michael Dance, Rex Caffey

Faculty Publications

No abstract provided.

Cortical Microstructural Changes Associated With Treated Aphasia Recovery, Allen J. Chang, Janina Wilmonskoetter, Julius Fridriksson, Emilie R. Mckinnon, Lorelei P. Johnson, Alexandra Basilakos, Jens H. Jensen, Chris Rorden, Leonardo Bonilha

Faculty Publications

Objectives

To investigate the hypothesis that language recovery in post-stroke aphasia is associated with structural brain changes.

Methods

We evaluated whether treatment-induced improvement in naming is associated with reorganization of tissue microstructure within residual cortical regions. To this end, we performed a retrospective longitudinal treatment study using comprehensive language-linguistic assessments and diffusion MRI sequences optimized for the assessment of complex microstructure (diffusional kurtosis imaging) to evaluate the relationship between language treatment response and cortical changes in 26 individuals with chronic stroke-induced aphasia. We employed elastic net statistical models controlling for baseline factors including age, sex, and time since the stroke, …

Effect Of An Antenatal Lifestyle Intervention On Dietary Inflammatory Index And Its Associations With Maternal And Fetal Outcomes: A Secondary Analysis Of The Pears Trial, Sarah Louise Killen, Catherine M. Phillips, Anna Delahunt, Cara A. Yelverton, Nitin Shivappa Mbbs, Mph, Ph.D., James Hébert Scd, Maria A. Kennelly, Martina Cronin, John Mehegan, Fionnuala M. Mcauliffe

Faculty Publications

We investigated the effect of an antenatal lifestyle intervention of a low-glycaemic index (GI) diet and physical activity on energy-adjusted dietary inflammatory index (E-DIITM) and explored its relationship with maternal and child health in women with overweight and obesity. This was a secondary analysis of 434 mother−child pairs from the Pregnancy Exercise and Nutrition Study (PEARS) trial in Dublin, Ireland. E-DII^TM scores were calculated for early (10–16 weeks) and late (28 weeks) pregnancy. Outcomes included lipids, inflammation markers, insulin resistance, mode of delivery, infant size, pre-eclampsia, and gestational diabetes. T-tests were used to assess changes in E-DII^TM. …

Daily Energy Expenditure Through The Human Life Course, Herman Pontzer, Yosuke Yamada, Hiroyuki Sagayama, Philip N. Ainslie, Lene F. Andersen, Liam J. Anderson, Lenore Arab, Issaad Baddou, Kweku Bedu-Addo, Ellen E. Blaak, Stephane Blanc, Alberto G. Bonomi, Carlijn V.C. Bouten, Pascal Bovet, Maciej S. Buchowski, Nancy F. Butte, Stefan G. Camps, Graeme L. Close, Jamie A. Cooper, Richard Cooper, Sai Krupa Das, Lara R. Dugas, Ulf Ekelund, Sonja Entringer, Terrence Forrester, Barry W. Fudge, Annelies H. Goris, Michael Gurven, Catherine Hambly, Asmaa El Hamdouchi, Marjije B. Hoos, Sumei Hu, Noorjehan Joonas

Faculty Publications

Total daily energy expenditure (“total expenditure”) reflects daily energy needs and is a critical variable in human health and physiology, but its trajectory over the life course is poorly studied. We analyzed a large, diverse database of total expenditure measured by the doubly labeled water method for males and females aged 8 days to 95 years. Total expenditure increased with fat-free mass in a power-law manner, with four distinct life stages. Fat-free mass-adjusted expenditure accelerates rapidly in neonates to ~50% above adult values at ~1 year; declines slowly to adult levels by ~20 years; remains stable in adulthood (20 to …

Independent Contributions Of Structural And Functional Connectivity: Evidence From A Stroke Model, Lynsey M. Keator, Grigori Yourganov, Alexandra Basilakos, Argye E. Hillis, Gregory Hickok, Leonardo Bonilha, Chris Rorden, Julius Fridriksson

Faculty Publications

Altered functional connectivity is related to severity of language impairment in poststroke aphasia. However, it is not clear whether this finding specifically reflects loss of functional coherence, or more generally, is related to decreased structural connectivity due to cortical necrosis. The aim of the current study was to investigate this issue by factoring out structural connectivity from functional connectivity measures and then relating the residual data to language performance poststroke. Ninety-seven participants with a history of stroke were assessed using language impairment measures (Auditory Verbal Comprehension and Spontaneous Speech scores from the Western Aphasia Battery-Revised) and MRI (structural, diffusion tensor …

Adaptation Of The Agency For Healthcare Research And Quality’S ‘Hospital Survey On Patient Safety Culture’ To The Bosnia And Herzegovina Context, Šehad Draganović, Guido Offermanns, Rachel E. Davis

Faculty Publications

OBJECTIVES: Measuring staff perspectives on patient safety culture (PSC) can identify areas of concern that, if addressed, could lead to improvements in healthcare. To date, there is no validated measure to assess PSC that has been tested and adapted for use in Bosnia and Herzegovina (BiH). This research addresses the gap in the evidence through the psychometric assessment of the Agency for Healthcare Research and Quality's: 'Hospital Survey on Patient Safety Culture' (HSOPSC), to determine its suitability for the health system in BiH. SETTING: Nine hospitals. PARTICIPANTS: Healthcare professionals (n=1429); nurse (n=823), doctors (n=328), other clinical personnel (n=111), non-clinical personnel …

Covid-19 Disrupted Provision And Utilization Of Health And Nutrition Services In Uttar Pradesh, India: Insights From Service Providers, Household Phone Surveys, And Administrative Data, Phuong H. Nguyen, Shivani Kachwaha, Anjali Pant, Lan M. Tran, Monika Walia, Sebanti Ghosh, Praveen K. Sharma, Jessica Escobar-Alegria, Edward A. Frongillo Jr., Purnima Menon, Rasmi Avula

Faculty Publications

BACKGROUND: The coronavirus (COVID-19) pandemic may substantially affect health systems, but little primary evidence is available on disruption of health and nutrition services. OBJECTIVES: This study aimed to 1) determine the extent of disruption in provision and utilization of health and nutrition services induced by the pandemic in Uttar Pradesh, India; and 2) identify how adaptations were made to restore service provision in response to the pandemic. METHODS: We conducted longitudinal surveys with frontline workers (FLWs, n = 313) and mothers of children < 2 y old (n = 659) in December 2019 (in-person) and July 2020 (by phone). We also interviewed block-level managers and obtained administrative data. We examined changes in service provision and utilization using Wilcoxon matched-pairs signed-rank tests. RESULTS: Compared with prepandemic, service provision reduced substantially during lockdown (83-98 percentage points, pp), except for home visits and take-home rations (∼ 30%). Most FLWs (68%-90%) restored service provision in July 2020, except for immunization and hot cooked meals (< 10%). Administrative data showed similar patterns of disruption and restoration. FLW fears, increased workload, inadequate personal protective equipment (PPE), and manpower shortages challenged service provision. Key adaptations made to provide services were delivering services to beneficiary homes (∼ 40%-90%), social distancing (80%), and using PPE (40%-50%) and telephones for communication (∼ 20%). On the demand side, service utilization reduced substantially (40-80 pp) during the lockdown, but about half of mothers received home visits and food supplementation. Utilization for most services did not improve after the lockdown, bearing the challenges of limited travel (30%), nonavailability of services (26%), and fear of catching the virus when leaving the house (22%) or meeting service providers (14%). CONCLUSIONS: COVID-19 disrupted the provision and use of health and nutrition services in Uttar Pradesh, India, despite adaptations to restore services. Strengthening logistical support, capacity enhancement, performance management, and demand creation are needed to improve service provision and utilization during and post-COVID-19.