Digital Commons Network^™

The Al-Bahah Paradox: Divergent Patterns Of Increased And Decreased Infectious Disease Incidence Relative To National Saudi Rates Over 12 Years Of Surveillance, Mohammed A. A. Alqumber

Saudi Medical Journal

Objective: To identify statistically significant deviations in notifiable infectious disease incidence between Al-Bahah region and national Saudi averages, and to generate hypotheses that may inform future epidemiological, microbiological, and public health investigations. Methods: In April 2026, a 12-year retrospective ecological study (2013–2024) was conducted using surveillance data from the Saudi Ministry of Health for 37 notifiable infectious diseases across 20 health regions. Cumulative incidence rates, standardized morbidity ratios (SMRs), and Z-tests compared observed cases in Al-Bahah against national estimates. Results: Overall incidence was 15.8% lower in Al-Bahah than nationally (86.42 versus 102.68; incidence rate ratios = 0.842; p …

Epidemiology Of Lower Extremity Amputations In The United States: An Analysis Of The Global Burden Of Disease Database From 1990 To 2019, Peter B. Spencer, Cameron J. Sabet, Gabrielle Dykhouse, Taylor Manes, Phillip C. Mckegg, Ambrose Loc T. Ngo, Ayah Ibrahim, Jack W. Weick

Student Publications

Background: Lower extremity amputations (LEAs) are medically, psychologically, and functionally devastating. The objective of our study was to evaluate region- and sex-specific differences of unilateral and bilateral LEAs across the United States (US) from 1990 to 2019.

Methods: The Global Burden of Disease database was used to analyze years lived with disability (YLDs), prevalence, and incidence rates per 100,000 people for LEAs in the US from 1990 to 2019. Data were stratified into four US Census Bureau-defined regions: Northeast, Midwest, South, and West. Differences between regions and sexes were assessed, with statistical significance defined as p < 0.05.

Results: From 1990 to …

Epidemiology Of Lower Extremity Amputations In The United States: An Analysis Of The Global Burden Of Disease Database From 1990 To 2019., Peter B Spencer, Cameron J Sabet, Gabrielle Dykhouse, Taylor J Manes, Phillip C Mckegg, Ambrose Loc T Ngo, Ayah Ibrahim, Jack Weick

Surgery Articles

BACKGROUND: Lower extremity amputations (LEAs) are medically, psychologically, and functionally devastating. The objective of our study was to evaluate region- and sex-specific differences of unilateral and bilateral LEAs across the United States (US) from 1990 to 2019.

METHODS: The Global Burden of Disease database was used to analyze years lived with disability (YLDs), prevalence, and incidence rates per 100,000 people for LEAs in the US from 1990 to 2019. Data were stratified into four US Census Bureau-defined regions: Northeast, Midwest, South, and West. Differences between regions and sexes were assessed, with statistical significance defined as p < 0.05.

RESULTS: From 1990 to …

Epidemiological-Based Study Of Sars-Cov-2 In Faisalabad, Sana Ullah, Muhammad Waseem Khan, Qurat-Ul- Ain, Khushbu Farva, Niaz Muhammad Khan, Hayat Ullah

Biological Engineering Student Research

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) raced around the world across different populations; there needs to be a consolidated effort to understand the divergence of the epidemiology of SARS-CoV-2. Population-based epidemiological characteristics studies measure the extent of SARS-CoV-2 infection in a country. The current research study was designed to report epidemiological data from Pakistan. For this purpose, 246 SARS-CoV-2-infected patients were included in the study. For SARS-CoV-2 confirmation, viral samples were collected from all the study participants; SARS-CoV-2 infection was confirmed by viral nucleic acid detection using a nucleic acid detection kit. After SARS-CoV-2 confirmation, all the study participants …

Leishmania In Texas: A Contemporary One Health Scoping Review Of Vectors, Reservoirs, And Human Health, Morgan H Jibowu, Richard Chung, Nina L Tang, Sarah Guo, Leigh-Anne Lawton, Brendan J Sullivan, Dawn M Wetzel, Sarah M Gunter

Faculty, Staff and Students Publications

Leishmaniasis, a vector-borne neglected tropical disease, affects over 6.2 million people globally. Case acquisition is increasingly recognized in the United States, and in Texas, most reported cases are locally acquired and speciated to Leishmania mexicana. We conducted a scoping literature review to systematically assess contemporary research on Leishmania in humans, animals, reservoir hosts, or vectors in Texas after 2000. Out of 22 eligible studies, the most prevalent themes were case reports, followed by studies on domestic animals, reservoirs, and vectors, with several studies bridging multiple disciplines. Climate change, urbanization, and habitat encroachment appear to be driving the northward expansion …

Investigating Environmental And Socioeconomic Contributors To Adult Obesity In The Rio Grande Valley, John Nicholas Cauba, Jihoo Woo, Russel Wiggins, Shizue Mito

School of Medicine Publications

Obesity in the Rio Grande Valley (RGV) of Texas remains a critical public health concern, with rates (46.9%) significantly exceeding those of Texas (36%) and the U.S. (34%) (p < 0.001). This study used 2024 County Health Rankings data to analyze environmental and socioeconomic contributors to obesity across 240 Texas counties, with a population-weighted focus on Hidalgo, Cameron, Starr, and Willacy counties. The RGV exhibited markedly poorer access to exercise, higher rates of physical inactivity, lower Food Environment Index scores (FEI = 4.3 vs. 5.7 in Texas), higher rates of uninsurance, worse patient-to–primary care physician (PCP) ratios (2152:1 vs. Texas 1660:1), and increased preventable hospitalizations. Multiple linear regression identified physical inactivity (β = 0.6, p = 0.01) and access to exercise (β = −0.02, p = 0.02) as significant predictors of obesity. Notably, higher uninsured rates were associated with lower reported obesity, likely due to underdiagnosis in the absence of routine care. These findings emphasize the need for targeted interventions addressing food access, environmental and recreational infrastructure, along with healthcare infrastructure in the RGV, where socioeconomic disadvantage and structural barriers magnify the impact of national obesity trends on the regional level.

Epidemiologic Trends In Cutaneous Squamous Cell Carcinoma From 2011 To 2021 At All Africa Leprosy, Tuberculosis, And Rehabilitation Training Center (Alert) In Addis Ababa, Ethiopia, Tizita Yosef, Wondwossen Ergete, Rishab R Revankar, Heli A. Patel, Tsegaye Hailu Kumsa, Vishal A Patel, Selfu Girma, Benjamin K Stoff

SKMC Student Presentations and Publications

BACKGROUND: Cutaneous squamous cell carcinoma (cSCC) is the most common keratinocyte carcinoma in dark-skinned ethnic groups. Available studies are primarily focused on white populations, with fewer data available for black Africans, including Ethiopians. Therefore, less priority may be given to treatment and prevention in this population.

OBJECTIVE: To determine the prevalence and risk factors of cSCC among patients presenting to All Africa Leprosy, Tuberculosis, and Rehabilitation Training Center , Addis Ababa, Ethiopia.

METHODS: A literature review was performed to determine existing knowledge. A retrospective descriptive cross-sectional study was then conducted based on stored data of confirmed cases of cSCC from …

Identifying The Multilevel Factors Influencing Provider Recommendations For Adolescent Vaccines, Mallory Kathryn Ellingson

Yale Graduate School of Arts and Sciences Dissertations

Health care provider (HCP) recommendations are a key predictor of vaccineacceptance among parents of adolescents. However, HCP recommendations for adolescent vaccines are not universal. In order to address disparities in HCP recommendations, we must first understand why recommendations vary. The factors that influence a HCP recommendation are multilevel. At the individual level, a HCP’s own knowledge, attitudes and beliefs about a vaccine can influence how or if they recommend the vaccine to a patient. At the interpersonal level, the characteristics of the patient can impact how a HCP perceives disease risk or need for a vaccine in their patient. At …

A Structured Review Of The Associations Between Breast Cancer And Exposures To Selected Organic Solvents, Sydney Westra, Mark S. Goldberg, France Labrèche, Jill Baumgartner, Vikki Ho

Revues de littérature, synthèses de connaissances

Introduction

Our objective was to identify published, peer-reviewed, epidemiological studies that estimated associations between the risk of developing or dying from malignant breast cancer and past exposure to selected organic solvents with reactive metabolites, to delineate the methods used and to synthesize the results.

Content

We undertook a structured review of case-control and cohort studies used to investigate breast cancer risk and exposure to selected organic solvents that produce reactive metabolites in the body. We used SCOPUS, MEDLINE (Ovid) and Web of Science databases from 1966 to December 31, 2023 to identify epidemiological studies that estimated associations between the risk …

Influence Of Seasonality And Public-Health Interventions On The Covid-19 Pandemic In Northern Europe, Gerry A. Quinn, Michael Connolly, Norman E. Fenton, Steven J. Hatfill, Paul Hynds, Coilín Óhaiseadha, Karol Sikora, Willie Soon, Ronan Connolly

Articles

Background: Most government efforts to control the COVID-19 pandemic revolved around non-pharmaceutical interventions (NPIs) and vaccination. However, many respiratory diseases show distinctive seasonal trends. In this manuscript, we examined the contribution of these three factors to the progression of the COVID-19 pandemic. Methods: Pearson correlation coefficients and time-lagged analysis were used to examine the relationship between NPIs, vaccinations and seasonality (using the average incidence of endemic human beta-coronaviruses in Sweden over a 10-year period as a proxy) and the progression of the COVID-19 pandemic as tracked by deaths; cases; hospitalisations; intensive care unit occupancy and testing positivity rates in six …

Incorporating Resilience When Assessing Pandemic Risk In The Arctic: A Case Study Of Alaska, Sweta Tiwari, Andrey Petrov, Nino Mateshvili, Michele Devlin, Nikolay Golosov, Marya Rozanova-Smith, Mark Welford, John Degroote, Tatiana Degai, Stanislav Ksenofontov

Faculty Publications

The discourse on vulnerability to COVID-19 or any other pandemic is about the susceptibility to the effects of disease outbreaks. Over time, vulnerability has been assessed through various indices calculated using a confluence of societal factors. However, categorising Arctic communities, without considering their socioeconomic, cultural and demographic uniqueness, into the high and low continuum of vulnerability using universal indicators will undoubtedly result in the underestimation of the communities' capacity to withstand and recover from pandemic exposure. By recognising vulnerability and resilience as two separate but interrelated dimensions, this study reviews the Arctic communities' ability to cope with pandemic risks. In …

Pubh 8133 – Advanced Epidemiology, Yelena Tarasenko

College of Public Health: Faculty Syllabi (2014-2021)

An in-depth integration of advanced epidemiology concepts designed to reinforce epidemiological principles, as well as build a foundation for epidemiologic research in public health practice. Specific course content includes theory, methods, and applications for epidemiologic studies including random and systematic error, confounding, counterfactuals, causal inference, effect modification, internal and external validity and advanced study design. Emphasis will also be placed on choosing and performing appropriate analytic techniques necessary for biostatistical inference, including estimation and interpretation of effect measures.

Global Trends In Adolescents' Road Traffic Injury Mortality, 1990-2019, Uzma Rahim Khan, Junaid A. Razzak, Martin Gerdin Wärnberg

Department of Emergency Medicine

Objective: The aim of this study was to determine the trends of road traffic injury (RTI) mortality among adolescents aged 10-14 years and 15-19 years across different country income levels with respect to the type of road users from 1990 to 2019.
Methods: We conducted an ecological study. Adolescents' mortality rates from RTIs at the level of high-income countries (HICs), upper-income to middle-income countries (UMICs), lower-income to middle-income countries and low-income countries were extracted from the Global Burden of Disease study. Time series were plotted to visualise the trends in mortality rates over the years. We also conducted Poisson regression …

Epidemiology Of Covid-19: What Changed In One Year?, Cemal Bulut, Yasuyuki̇ Kato

Turkish Journal of Medical Sciences

A coronavirus brought the first pandemic attack of this century as a flu virus did a hundred years ago. This greatest pandemic of the century brings us new opportunities to understand and explore the dynamics of a contagious disease. Nearly two years later, we are still collecting the evidence to understand the disease. Some basic epidemiological properties are still urgently needed. Not only the origin of the virus but also Ro value, possible transmission routes, epidemiologic curves, case fatality rates, seasonality, severity and mortality risk factor, effects on the risk groups, differences between countries and so on still require strong …

Applied Methodologies Demonstrated Through Three Independent Studies For Assessing The Effects Of Socioeconomic, Environmental Chemical Exposure, And Therapeutic Factors On Oncological Diseases And Covid-19, Bayarmagnai Maggie Munkhjargal

Legacy Theses & Dissertations (2009 - 2024)

When trying to understand risk factors for a disease, even before we know the causal agents, it is necessary to create a surveillance data set that answers the questions of who, when, and where, and includes any potential covariates which may either promote or prevent the disease. There are a wide variety of surveillance data. For example, hospital discharge data, such as the New York Statewide Planning and Research Cooperative System (SPARCS) data, encompass all hospitalized cases in the state, while clinical datasets cover a specially constructed population in pursuit of research of a certain disease type. Analysis of surveillance …

Spatiotemporal Epidemiology Of Varicella In Chongqing, China, 2014-2018, Hua Zhu, Han Zhao, Rong Ou, Qing Zeng, Ling Hu, Hongfang Qiu, Manoj Sharma, Mengliang Ye

Environmental & Global Health Faculty Research

Although immunization against varicella using vaccines has been proven to be significant and effective in the past decades, varicella remains a major public health concern for many developing countries. Varicella vaccination has not been introduced into routine immunization programs in China, and varicella outbreaks have continued to occur. Taking the city of Chongqing, which has a high prevalence of varicella, as an example, this study explored the spatiotemporal epidemiology of varicella. Based on the reported data of varicella cases from 1 January 2014 to 31 December 2018 in Chongqing, hot spots and space-time clusters of varicella were identified using spatial …

Is There Less Opioid Abuse In States Where Marijuana Has Been Decriminalized, Either For Medicinal Or Recreational Use? A Clin-Iq, Aaron M. Wendelboe, Richard Mathew, Tana Chongsuwat, Elizabeth Rainwater, Mark A. Wendelboe, Elizabeth Wickersham Md, Ann F. Chou

Journal of Patient-Centered Research and Reviews

Opioid use, abuse, and associated mortality have reached an epidemic level. In some states, cannabis is being used to treat chronic pain. To examine the hypothesis that medical marijuana legislation may reduce adverse opioid-related outcomes if patients substitute cannabis for opioids for pain management, we conducted a clinical inquiry (Clin-IQ). We searched Ovid MEDLINE, Ovid MEDLINE In-Process, and Embase for studies using the search terms marijuana, cannabis, legal, marijuana smoking, medical marijuana, opioid-related disorders, cannabis use, medical cannabis, legal aspect, and opiate addiction. We included population-based articles published from January 1, 2012, through December 5, 2018, that assessed the relationship …

An Exploration Of Colorectal Cancer Incidence Rates In North Dakota, Usa, Via Structural Equation Modeling, Gary G. Schwartz, Marilyn G. Klug, Bradley C. Rundquist

Geography & Geographic Information Science Faculty Publications

Purpose The state of North Dakota has one of the highest incidence rates for colorectal cancer in the USA. Its high incidence rate, coupled with a large variation in incidence rates among counties within the state, makes North Dakota a “natural laboratory” in which to investigate environmental clues to colorectal cancer. We conducted a hypothesis-generating study to explore potential determinants of colorectal cancer in North Dakota.

Methods We obtained county-specific incidence rates for North Dakota’s 53 counties from the statewide cancer registry and corresponding data on county demographic, agricultural, and geophysical features from population-based sources. Candidate demographic/agricultural variables included median …

Epilepsy Diagnosis And Management Of Children In Kenya: Review Of Current Literature, Pauline Samia, Jane Hassell, Jessica-Anne Hudson, Symon M. Kariuki, Charles R. Newton, Jo M. Wilmshurst

Paediatrics and Child Health, East Africa

Introduction: The growing impact of non-communicable diseases in low- to middle-income countries makes epilepsy a key research priority. We evaluated peer-reviewed published literature on childhood epilepsy specific to Kenya to identify knowledge gaps and inform future priorities.

Methodology: A literature search utilizing the terms “epilepsy” OR “seizure” as exploded subject headings AND “Kenya” was conducted. Relevant databases were searched, generating 908 articles. After initial screening to remove duplications, irrelevant articles, and publications older than 15 years, 154 papers remained for full-article review, which identified 35 publications containing relevant information. Data were extracted from these reports on epidemiology, etiology, clinical features, …

Evolutionary Dynamics Of Influenza Type B In The Presence Of Vaccination: An Ecological Study, Lindsey J. Fiedler

USF Tampa Graduate Theses and Dissertations

Understanding the evolutionary dynamics of influenza type B in human hosts is a public health concern as we strive to minimize the disease burden in seasonal epidemics. Vaccination is considered the best defense against contracting influenza, and everyone over the age of 6 months is advised to get vaccinated before each season. The effect that vaccine-acquired immunity has on the evolution of influenza B remains unclear. In the U.S., vaccine-uptake is irregular across the states, and the differing coverages present an opportunity to study how vaccination influences viral evolution. This thesis analyzes the evolutionary patterns of influenza B in the …

Respiratory Infections And Risk For Development Of Narcolepsy: Analysis Of The Truven Health Marketscan Database (2008 To 2010) With Additional Assessment Of Incidence And Prevalence, Darren Scheer

USF Tampa Graduate Theses and Dissertations

Background and Significance: Narcolepsy is a chronic neurological disorder. These patients experience various psychiatric and physical comorbid diseases and mortality at an increased rate compared to the general population. Additionally, patients with narcolepsy experience approximately a doubling of various annual healthcare related facility visits, transactions, and costs comparatively. Narcolepsy with cataplexy is generally believed to be more prevalent than narcolepsy without cataplexy. However, incidence and prevalence estimates of narcolepsy (with or without cataplexy) vary widely with few large epidemiological studies conducted worldwide and none in the U.S evaluating these proportions in both children and adults utilizing a large health care …

Evaluation By Geospatial And Spatiotemporal Distribution Of Tularemia Cases In Arkansas, Toni Kathleen Beavers

Walden Dissertations and Doctoral Studies

Tularemia is a vector-borne disease of global concern with diverse regional foci. Arkansas is an endemic state with differences in case distribution and land suitability supporting host and vector sustainment. The aim of this study was to conduct a geospatial and spatiotemporal assessment of factors associated with case distribution and timeliness and completeness of public reporting. Guided with direction from spatial epidemiology and nidality, referring to the association of ecology, climate, and proximity of disease, analysis included secondary data collected from the Arkansas Department of Health between 1995 and 2018. Using Poisson-based software, 2 clusters were found: a high-risk cluster …

Lead And Crime: An Ecological Study Between Lead Contaminated Topsoil And Violent Crime., Brian Guinn

Electronic Theses and Dissertations

Lead is a known neurotoxicant. Human exposure to lead comes primarily through environmental exposures, including remnant lead paint, lead contaminated topsoil and lead contaminated water. Prenatal and early life lead exposure has been associated with numerous neurocognitive and neuropsychiatric disorders. This dissertation presents findings from an ecological study which evaluated the geospatial association between topsoil lead content and the incidence of FBI designated violent crime in Jefferson County, Kentucky. A total of 412 topsoil samples were collected along roadways (n=300) and from Louisville Metro Parks (n=112). Jefferson County crime data was obtained from the Louisville Metro Police Department – Crime …

Distribution Of Pulmonary Tuberculosis In Rio De Janeiro (Brazil): A Spatial Analysis, Nadia Christina Rodrigues, Monica Kramer Andrade, Gisele O'Dwyer, Matthew B. Flynn, Jose Ueleres Braga, Andrea Sobral De Almeida, Leonardo Soares Bastos, Valeria Teresa Saraiva Lino

Political Science & International Studies: Faculty Publications

The aim of this study was to analyze the spatial distribution of the tuberculosis endemic in Rio de Janeiro State from 2002 to 2011. A retrospective study was conducted in the state of Rio de Janeiro from 2002 to 2011. Spatial analysis techniques were used to describe the distribution of tuberculosis incidence in the state. Multilevel Poisson regression model was used to access the relationship of tuberculosis and the following factors: “sex”, “age-group” and “diagnostic year” (individual-level factors). Demographic density and municipality were also included in the model as contextual-level factors. A reduction in endemic tuberculosis was observed over the …

The Increase In Domestic Violence In Brazil From 2009-2014, Nadia Christina Rodrigues, Gisele O'Dwyer, Monica Kramer Andrade, Matthew B. Flynn, Denise Leite Maia Monteiro, Valeria Teresa Saraiva Lino

Political Science & International Studies: Faculty Publications

In recent decades, the rise violent phenomena in Brazil has reached epidemic proportions. However, the prevalence of domestic violence (DV) across different states in the country is not well established. The objective of this study was to describe the distribution of DV across Brazilian states from 2009 to 2014. An ecological study based on spatial analysis techniques was performed using Brazilian states as geographical units of analysis. A multilevel Poisson model was used to explain the risk of DV in Brazil according to age, sex, period (fixed effects), the Human Developing Index, and the victim’s residence state (random effects). The …

Ebola Virus - Epidemiology, Diagnosis, And Control: Threat To Humans, Lessons Learnt, And Preparedness Plans - An Update On Its 40 Year's Journey, Raj Kumar Singh, Kuldeep Dhama, Yashpal Singh Malik, Muthannan Andavar Ramakrishnan, Kumaragurubaran Karthik, Rekha Khandia, Ruchi Tiwari, Ashok Munjal, Mani Saminathan, Perumal Arumugam, Sunil Kumar Joshi

Bioelectrics Publications

Ebola virus (EBOV) is an extremely contagious pathogen and causes lethal hemorrhagic fever disease in man and animals. The recently occurred Ebola virus disease (EVD) outbreaks in the West African countries have categorized it as an international health concern. For the virus maintenance and transmission, the non-human primates and reservoir hosts like fruit bats have played a vital role. For curbing the disease timely, we need effective therapeutics/prophylactics, however, in the absence of any approved vaccine, timely diagnosis and monitoring of EBOV remains of utmost importance. The technologically advanced vaccines like a viral-vectored vaccine, DNA vaccine and virus-like particles are …

Ecological Correlations Of Dietary Food Intake And Mental Health Disorders, Jordan Hoerr, Joshua Fogel, Benjamin Van Voorhees

Publications and Research

This paper examines the ecological association of dietary food intake with mental health outcomes on the group level across countries. Published data from the World Mental Health Survey were used to compare lifetime prevalence of four categories of mental health disorders (anxiety disorders, mood disorders, impulse control disorders, and substance use disorders) with a country’s fish/seafood and sugar/sweetener supply quantity using the Spearman rank correlation. Data were compared for 17 countries across the world. Sugar and sweetener supply quantity was significantly and positively associated with anxiety disorders (rho = 0.75, p = 0.001), mood disorders (rho = 0.75, p = …

Review: Epidemiological Evidence Of Groundwater Contribution To Global Enteric Disease, 1948–2015, Heather Murphy, Morgan Prioleau, Mark Borchardt, Paul Hynds

Articles

Globally, approximately 2.2 billion people rely on groundwater for daily consumption. It is widely accepted that groundwater is more pristine than surface water but while this assumption is frequently the case, groundwater is not ubiquitously free of contaminants; accordingly, this presumption can result in an unfounded and potentially hazardous sense of security among owners, operators and users. The current paper presents a review of published literature providing epidemiological evidence of the contribution of groundwater to global human enteric infection. An emphasis is placed on enteric pathogens transmitted via the faecal-oral route, and specifically those associated with acute gastrointestinal illness (AGI). …

Consumption Of Sugar-Sweetened Beverages Associated With Increased Odds Of Depression, Chad E. Burleson, Kendall Anderson, Z. Copeland, Kelly L. Sullivan

Epidemiology: Faculty Publications (2002-2018)

Objective: To evaluate the association between depression and sugary drink intake using participant data from the Behavioral Risk Factor Surveillance Survey (BRFSS).

Design: Cross-sectional data from the 2012 and 2013 BRFSS were examined (N=44,603). Depression was based on self-report of symptoms within the past 30 days. Covariates included age, sex, race, employment status, body mass index (BMI), education level, and exercise in the past 30 days.

Setting: Data from a national telephone survey (BRFSS) were used to assess risk factors associated with health of the participants.

Subjects: Participants in the 2012 and 2013 BRFSS were included in this analysis (N=44,603). …

Effect Of Primary Care Physician Density On Late Stage Cervical Cancer Diagnosis, Emily Haanschoten

Theses and Dissertations

INTRODUCTION: Late-stage cervical cancer diagnosis is an important contributing factor to the cervical cancer mortality rate. Screening for cervical cancer is a vital tool in reducing the number of late-stage cases, preventing incident cases and reducing mortality. Access to care is often a significant barrier to receiving these services. Women who have no usual source of care report significantly lower percentages of Pap tests than women who have a usual source. South Carolina ranks 13th in the US in cervical cancer incidence and 7th in cervical cancer mortality. South Carolina also struggles with a primary care physician shortage, ranking 39th …