Public Health Commons^™

Effects Of The Affordable Care Act On The Receipt Of Colonoscopies Among The Insured Elderly, Minjee Lee, M Mahmud Khan, Heather M. Brandt, Ramzi G. Salloum, Brian Chen

Faculty Publications

BACKGROUND: The Affordable Care Act (ACA) waived deductibles and eliminated coinsurance for colonoscopies for Medicare beneficiaries beginning in January 1, 2011. This study investigated the effect of the ACA's directive to remove the financial barriers on the receipt of colonoscopies among the elderly insured, who are predominantly covered by Medicare. METHODS: Data from the 2008-2016 Behavioral Risk Factor Surveillance System (BRFSS) were used to examine the receipt of colonoscopies in two years prior to the implementation of the ACA (2008 and 2010) and three years after the change (2012, 2014, and 2016). Multivariate logistic regressions were estimated to examine the …

Evaluation Of Global Health Capacity Building Initiatives In Low-And Middle-Income Countries: A Systematic Review, Hady Naal, Maria El Koussa, Melissa El Hamouch, Layal Hneiny, Shadi Saeh

Faculty Publications

Background Low- and middle-income countries (LMICs) are in dire need to improve their health outcomes. Although Global Health Capacity Building (GHCB) initiatives are recommended approaches, they risk being ineffective in the absence of standardized evaluation methods. This study systematically reviews evaluation approaches for GHCB initiatives in LMICs. Methods We searched the Medline (OVID), PubMed, Scopus, and Embase.com databases for studies reporting evaluation of a GHCB initiative in a LMIC from January 1, 2009 until August 15, 2019. To differentiate them from intervention, prevention, and awareness initiatives, included articles reported at least one approach to evaluate their learning modality. We excluded …

Covid-19 In Indigenous Communities: Five Protective Factors Of “Exercising” Sovereignty, Kelsey Leonard, Natalie Welch, Alisse Ali-Joseph

Faculty Publications

Indigenous Peoples have an inherent responsibility and right to “exercising” sovereignty - the practice of sport and physical activity in performance of our cultural, political, and spiritual citizenship (Ali-Joseph 2018). During the COVID-19 pandemic, access to and equity (inequity) in sport and physical activity has been felt (physically, spiritually, politically) within Indigenous communities. We implement an abundance-based Indigenous approach to understanding Indigenous Peoples’ responses to the coronavirus pandemic through sport and its far-reaching ramifications in Indian Country. In response to the COVID-19 pandemic we have seen Indigenous Peoples utilize social media such as Facebook and TikTok to reimagine Indigenous sport …

Mother-Child Dyadic Influences Of Affect On Everyday Movement Behaviors: Evidence From An Ecological Momentary Assessment Study, Chih-Hsiang Yang, Jimi Huh, Tyler B. Mason, Britni R. Belcher, Martina Kanning, Genevieve F. Dunton

Faculty Publications

Background

Research has shown that affect is associated with everyday movement behaviors in children and adults. However, limited work to date has investigated dyadic influences of momentary affect on moderate-to-vigorous physical activity (MVPA) and sedentary time among children and their mothers using ecological momentary assessment (EMA).

Methods

Mothers and their children (eight to 12-years-old at baseline) from the Los Angeles metropolitan area participated in a longitudinal study with six semi-annual measurement waves across three years. During each measurement wave, mothers and children reported momentary negative and positive affect via a custom smartphone-based EMA application across seven days (randomly sampled up …

Development Of A Clinical-Academic-Community Collaboration To Improve Health Literacy, Daniela B. Friedman Ph.D., Michelle A. Arent, Brooks Yelton Ma, Lmsw, Mayank Sakhuja, Venice E. Haynes, Samuel Noblet, Heather M. Brandt Ph.D., Ches, William D. Isenhower, Abraham Wandersman, Diana Zona, Cyndi New, Delores Fedrick, Jonathan Scaccia, Larisa Bruner

Faculty Publications

Limited health literacy is associated with poor patient health outcomes and increased hospitalization rates. Patient-provider communication plays an important role in patient health literacy and the understanding of medical terminology. This study demonstrates how a collaboration between clinical, academic, and community partners was instrumental in the design and implementation of a clinic readiness assessment and a clinic-based pilot intervention to encourage patient-provider communication and improve patient health literacy. A state hospital association, academic research team, and community adult literacy center director collaborated to develop a 60-item clinic readiness assessment and an evidence-informed pilot intervention. The clinic readiness assessment captured clinics’ …

A Multi-Stage Machine Learning Approach To Predict Dengue Incidence: A Case Study In Mexico, Annalisa Appice, Yulia R. Gel, Iliyan Iliev, Vyacheslav Lyubchich, Donato Malerba

Faculty Publications

© 2013 IEEE. The mosquito-borne dengue fever is a major public health problem in tropical countries, where it is strongly conditioned by climate factors such as temperature. In this paper, we formulate a holistic machine learning strategy to analyze the temporal dynamics of temperature and dengue data and use this knowledge to produce accurate predictions of dengue, based on temperature on an annual scale. The temporal dynamics are extracted from historical data by utilizing a novel multi-stage combination of auto-encoding, window-based data representation and trend-based temporal clustering. The prediction is performed with a trend association-based nearest neighbour predictor. The effectiveness …

Community Engagement And Outreach Programs For Lead Prevention In Mississippi, Amal K. Mitra, Charkarra Anderson-Lewis

Faculty Publications

The objective of the project was to encourage health promotion through education, outreach, and community-based training. The people attending health fairs (n = 467), community events (n = 469), and Kindergarten classes (n = 241) were the study participants. Hands-on training was offered at homebuilding retail stores (n = 25). U.S. Department of Housing and Urban Development (HUD)’s online visual training was given to realtors (n = 220), and inspectors, contractors, and Do-It-Yourself (DIY) workers (n = 75). Training workshops were attended by home-buyers and rental home owners at the Neighborhood Association Meetings ( …

Developing Implementation Research Capacity: Longitudinal Evaluation Of The King’S College London Implementation Science Masterclass, 2014-2019, Rachel Davis, Brian Mittman, Madelene Boyton, Aoife Keohane, Lucy Goulding, Jane Sandall, Graham Thornicroft, Nick Sevdalis

Faculty Publications

Background: Despite an increasing number of training opportunities in implementation science becoming available, the demand for training amongst researchers and practitioners is unmet. To address this training shortfall, we developed the King's College London 'Implementation Science Masterclass' (ISM), an innovative 2-day programme (and currently the largest of its kind in Europe), developed and delivered by an international faculty of implementation experts. Methods: This paper describes the ISM and provides delegates' quantitative and qualitative evaluations (gathered through a survey at the end of the ISM) and faculty reflections over the period it has been running (2014-2019). Results: Across the 6-year evaluation, …

Lobbying Expenditures Of The Health Sector During The Covid-19 Pandemic, Adam Olson, John Barrick, William B. Tayler, Shivaram Rajgopal, Ge Bai

Faculty Publications

As of June 30, 2020, Congress had enacted six bills authorizing approximately $3 trillion in COVID-19 pandemic relief, representing the largest relief package in US history. The bills allocate funds to federal agencies, health care providers, COVID-19 testing, Medicaid funding, stimulus checks, unemployment benefits, and small business assistance, among other purposes.1 Prior research has found that health care organizations spend substantial financial resources on influencing legislative outcomes.2,3 In this study, we examine lobbying efforts of the health sector relative to other sectors before and during the COVID-19 pandemic.

Mers-Cov Infection In South Korea And Strategies For Possible Future Outbreak: Narrative Review, Chulwoo Park

Faculty Publications

Although there were some positive viewpoints from international press and academia that the Republic of Korea (hereafter South Korea) successfully controlled the Middle East Respiratory Syndrome (MERS) outbreak in 2015, the domestic point of view towards the MERS response in South Korea was critical. As people in the world’s 11th largest economy, South Koreans criticized the failure of hospitals’ initial response to the MERS index case and the lack of a proper control strategy for secondary and tertiary cases. To contain the MERS outbreak, South Korea implemented mainly three MERS control and intervention strategies: quarantine and isolation system, temporary closure …

Sex Differences In Becoming A Current Electronic Cigarette User, Current Smoker And Current Dual User Of Both Products: A Longitudinal Study Among Mexican Adolescents, Rosibel Rodríguez-Bolaños, Edna Arillo-Santillán, Inti Barrientos-Gutiérrez, Luis Zavala-Arciniega, Charity A. Ntansah, Jim Thrasher

Faculty Publications

This study aimed to assess sex differences in predictors for becoming a current exclusive electronic cigarette (e-cigarette) user, current exclusive smoker, or current dual user (concurrent smoking and e-cigarette use). This longitudinal study included 2399 females and 2177 males who had tried neither cigarettes nor e-cigarettes at baseline and attended 57 middle schools in the three largest cities in Mexico. We estimated multinomial logistic models stratified by sex. At follow-up, the prevalence of current exclusive e-cigarette use was 6.4% for males and 5.5% for females; current exclusive smoking was similar among males (3.6%) and females (3.5%); dual use was 2.4% …

Validity Study Of The R-Pla, A Resilience Scale For People Living With Hiv, Jinxiang Hu, Julianne M. Serovich, Monique J. Brown, Judy A. Kimberly, Yi-Hsin Chen

Faculty Publications

This study provides psychometric assessment of a resilience scale with a sample of women living with HIV. Baseline data were used from a longitudinal HIV disclosure study of 124 women aged between 18-63 collected between 2001 and 2004 in a large Midwestern city. The Rasch model was used to examine the psychometric properties of the resilience scale. Results indicated that the resilience instrument meets the Rasch model application assumptions. Evidence of validity suggested the resilience instrument demonstrated good item and person fit, as well as good item and person reliability. Most items showed measurement invariance across different age and racial …

Small Molecules That Inhibit Tnf Signalling By Stabilising An Asymmetric Form Of The Trimer, James O'Connell, John Porter, Boris Kroeplien, Tim Norman, Stephen Rapecki, Rachel E. Davis, David Mcmillan, Tracy Arakaki, Alex Burgin, David Fox Iii, Tom Ceska, Fabien Lecomte, Alison Maloney, Alex Vugler, Bruce Carrington, Benjamin P. Cossins, Tim Bourne, Alastair Lawson

Faculty Publications

Tumour necrosis factor (TNF) is a cytokine belonging to a family of trimeric proteins; it has been shown to be a key mediator in autoimmune diseases such as rheumatoid arthritis and Crohn's disease. While TNF is the target of several successful biologic drugs, attempts to design small molecule therapies directed to this cytokine have not led to approved products. Here we report the discovery of potent small molecule inhibitors of TNF that stabilise an asymmetrical form of the soluble TNF trimer, compromising signalling and inhibiting the functions of TNF in vitro and in vivo. This discovery paves the way for …

Child-Level Double Burden Of Malnutrition In The Mena And Lac Regions: Prevalence And Social Determinants, Hala Ghattas Ph.D., Yubraj Acharya, Zeina Jamaluddine, Moubadda Assi, Khalil El Asmar, Andrew D. Jones

Faculty Publications

Although the prevalence of obesity has rapidly increased in the low- and middle-income countries of the Middle East and North Africa (MENA) and Latin America and the Caribbean (LAC) regions, child undernutrition remains a public-health challenge. We examined region-specific sociodemographic determinants of this double burden of malnutrition, specifically, the co-occurrence of child stunting and overweight, using Demographic and Health Survey and Multiple Indicator Cluster Survey data (2003–2016) from 11 countries in the MENA (n = 118,585) and 13 countries in the LAC (n = 77,824) regions. We used multiple logistic regressions to model region-specific associations of maternal education and household …

Chorioamnionitis: Case Definition & Guidelines For Data Collection, Analysis, And Presentation Of Immunization Safety Data, Alisa Kachikis, Linda O. Eckert, Christie Walker, Azucena Bardají, Frederick Varricchio, Heather S. Lipkind, Khady Diouf, Wan Ting Huang, Ronald Mataya, Mustapha Bittaye, Clare Cutland, Nansi S. Boghossian, Tamala Mallett Moore, Rebecca Mccall, Jay King, Shuchita Mundle, Flor M. Munoz, Caroline Rouse, Michael Gravett, Lakshmi Katikaneni, Kevin Ault, Nicola P. Klein, Drucilla J. Roberts, Sonali Kochhar, Nancy Chescheir

Faculty Publications

No abstract provided.

Neurodevelopmental Delay: Case Definition & Guidelines For Data Collection, Analysis, And Presentation Of Immunization Safety Data, Adrienne N. Villagomez, Flor M. Muñoz, Robin L. Peterson, Alison M. Colbert, Melissa Gladstone, Beatriz Macdonald, Rebecca Wilson, Lee Fairlie, Gwendolyn J. Gerner, Jackie Patterson, Nansi S. Boghossian, Vera Joanna Burton, Margarita Cortés, Lakshmi D. Katikaneni, Jennifer C.G. Larson, Abigail S. Angulo, Jyoti Joshi, Mirjana Nesin, Michael A. Padula, Sonali Kochhar, Amy K. Connery

Faculty Publications

No abstract provided.

Different Combinations Of Behavior Change Interventions And Frequencies Of Interpersonal Contacts Are Associated With Infant And Young Child Feeding Practices In Bangladesh, Ethiopia, And Vietnam, Sunny S. Kim, Phuong Hong Nguyen, Lan Mai Tran, Silvia Alayon, Purnima Menon, Edward A. Frongillo Jr.

Faculty Publications

Background: Social and behavior change communication interventions are integral to improving dietary and care practices, but evidence on the impact of the combination and intensity of these interventions in different contexts is scarce. Objectives: We examined the extent of and factors associated with intervention exposure: interpersonal communication (IPC) alone or with other interventions (i.e., mass media, community mobilization, or nutrition-sensitive agricultural activities), number of and factors associated with IPC contacts, and combinations of intervention components and number of contacts associated with infant and young child feeding (IYCF) practices. Methods: We used endline survey data from impact evaluations in Bangladesh, Ethiopia, …

Why Acute Ischemic Stroke Patients In The United States Use Or Do Not Use Emergency Medical Services Transport? Findings Of An Inpatient Survey, Sudha Xirasagar, Meng-Han Tsai, Khosrow Heidari, James W. Hardin, Yuqi Wu, Robert Wronski, Dana Hurley, Edward C. Jauch, Souvik Sen

Faculty Publications

Background: Patients with acute ischemic stroke (AIS) who use emergency medical services (EMS) receive quicker reperfusion treatment which, in turn, mitigates post-stroke disability. However, nationally only 59% use EMS. We examined why AIS patients use or do not use EMS.

Methods: During 2016–2018, a convenience sample of AIS patients admitted to a primary stroke center in South Carolina were surveyed during hospitalization if they were medically fit, available for survey when contacted, and consented to participate. The survey was programed into EpiInfo with skip patterns to minimize survey burden and self-administered on a touchscreen computer. Survey questions covered symptom characteristics, …

7-Epi-Clusianone, A Multi-Targeting Natural Product With Potential Chemotherapeutic, Immune-Modulating, And Anti-Angiogenic Properties, Wesley F. Taylor, Maria Yanez, Sara E. Moghadam, Mahdi Moridi Farimani, Sara Soroury, Samad N. Ebrahimi, Marzieh Tabefam, Ehsan Jabbarzadeh

Faculty Publications

Targeted therapies have changed the treatment of cancer, giving new hope to many patients in recent years. The shortcomings of targeted therapies including acquired resistance, limited susceptible patients, high cost, and high toxicities, have led to the necessity of combining these therapies with other targeted or chemotherapeutic treatments. Natural products are uniquely capable of synergizing with targeted and non-targeted anticancer regimens due to their ability to affect multiple cellular pathways simultaneously. Compounds which provide an additive effect to the often combined immune therapies and cytotoxic chemotherapies, are exceedingly rare. These compounds would however provide a strengthening bridge between the two …

Multilevel Analysis In Rural Cancer Control: A Conceptual Framework And Methodological Implications, Whitney Zahnd, Sara L. Mclafferty, Jan M. Eberth

Faculty Publications

Rural populations experience a myriad of cancer disparities ranging from lower screening rates to higher cancer mortality rates. These disparities are due in part to individual-level characteristics like age and insurance status, but the physical and social context of rural residence also plays a role. Our objective was two-fold: 1) to develop a multilevel conceptual framework describing how rural residence and relevant micro, macro, and supra-macro factors can be considered in evaluating disparities across the cancer control continuum and 2) to outline the unique considerations of multilevel statistical modeling in rural cancer research. We drew upon several formative frameworks that …

Humanitarian Engineering Design For Health Challenges: An Inter-Faculty Service Based Learning Model, Yara Najem, Imad H. Elhajj, Zaher Dawy, Aline Germani, Hala Ghattas Ph.D., Muhammad Zaman, Youseph Yazdi

Faculty Publications

The study introduces and evaluates a unique inter-faculty service learning course as a pedagogical model that enhances students’ learning and knowledge of health problems and associated engineering intervention design for populations affected by protracted crises.

Background: With an increase in humanitarian protracted crises around the world, due to conflict and natural disasters, we are in dire need to reinvent how we educate, train, and conduct research in these environments. Engineering and Health Sciences disciplines, individually and collectively, have been working to fill the gaps and address pressing public health issues. However, courses merging those disciplines and focusing on emerging humanitarian …

The Role Of Ict In Antiretroviral Therapy-Related Knowledge Seeking Among Older Chinese Living With Hiv, Yao Zhang, Xiaoming Li Ph.D., Shan Qiao Ph.D., Yuejiao Zhou, Zhiyong Shen

Faculty Publications

Antiretroviral therapy (ART) enables HIV patients to reduce disease progression. ART adherence is closely related to patients’ knowledge about the medical treatment. This study investigated the role of information and communication technologies (ICTs) in supporting ART-related knowledge seeking among older Chinese with HIV, using cross-sectional data collected from 2012 to 2013 in Guangxi, China. Of the 2987 HIV patients, 688 were 45 years or older and going through ART. We used an 11-item scale (α=0.69), which was developed based on existing literature, to assess ART-related knowledge to obtain a composite score (0-11). Less than 5% of the participants sought HIV-related …

The Empower Action Model: A Framework For Preventing Adverse Childhood Experiences By Promoting Health, Equity, And Well-Being Across The Life Span, Aditi Srivastav, Melissa Strompolis, Amy Moseley, Kelsay Shania Daniels

Faculty Publications

The empower action model addresses childhood adversity as a root cause of disease by building resilience across multiple levels of influence to promote health, equity, and well-being. The model builds on the current evidence around adverse childhood experiences and merges important frameworks within key areas of public health—the socio-ecological model, protective factors, race equity and inclusion, and the life course perspective. The socio-ecological model is used as the foundation for this model to highlight the multilevel approach needed for improvement in public health. Five key principles that build on the protective factors literature are developed to be applied at each …

Prospective Analysis Of Food Consumption And Nutritional Status And The Impact On The Dietary Inflammatory Index In Women With Breast Cancer During Chemotherapy, Isis Danyelle Dias Custódio, Fernanda De Paula Franco, Eduarda Da Costa Marinho, Taísa Sabrina Silva Pereira, Mariana Tavares Miranda Lima, Maria Del Carmen Bisi Molina, Nitin Shivappa, James R. Hébert, Carlos Eduardo Paiva, Yara Cristina De Paiva Maia

Faculty Publications

Considering the implications of adverse effects of chemotherapy (CT) and the potential impact of diet on patients’ recovery, this study aimed to prospectively evaluate the association between the consumption of food groups, patients’ Dietary Inflammatory Index (DII®) scores, and their nutritional status. Anthropometric and dietary assessments of 55 women with breast cancer (BC) were performed at three time points. T0 is the time point after the first CT cycle, T1 is the time point after the intermediate CT cycle, and T2 is the time point after the last CT cycle. We identified a significant increase in weight, body mass index, …

Inflammation And Acute Traffic-Related Air Pollution Exposures Among A Cohort Of Youth With Type 1 Diabetes, Robin C. Puett, Jeff D. Yanosky, Murray A. Mittleman, Jessica Montresor-Lopez, Ronny A. Bell, Tessa L. Crumee, Dana Dabeleae, Lawrence M. Dolan, Ralph B. D'Agostino Jr, Santica M. Marcovina, Catherine Pihokeri, Kristi Reynolds, Elaine Urbina, Angela D. Liese

Faculty Publications

Background: Evidence remains equivocal regarding the association of inflammation, a precursor to cardiovascular disease, and acute exposures to ambient air pollution from traffic-related particulate matter. Though youth with type 1 diabetes are at higher risk for cardiovascular disease, the relationship of inflammation and ambient air pollution exposures in this population has received little attention.

Objectives: Using five geographically diverse US sites from the racially- and ethnically-diverse SEARCH for Diabetes in Youth Cohort, we examined the relationship of acute exposures to PM2.5 mass, Atmospheric Dispersion Modeling System (ADMS)-Roads traffic-related PM concentrations near roadways, and elemental carbon (EC) with biomarkers of inflammation …

The Association Between Dietary Inflammatory Index (Dii) And Cancer Risk In Korea: A Prospective Cohort Study Within The Koges-Hexa Study, Injeong Ryu, Minji Kwon, Cheongmin Sohn, Nitin Shivappa, James R. Hébert, Woori Na, Mi Kyung Kim

Faculty Publications

Several epidemiological studies have shown that there are consistently positive associations between dietary inflammatory index (DII (R)) scores and cancer incidence in Western populations. However, few DII-cancer studies have been conducted in East Asian populations. In a large cohort representative of the general Korean population, we investigated whether the DII is associated with overall cancer risk. A total of 163,660 participants (56,781 males and 106,879 females) had evaluable data for analyses. This follow-up study was carried out over the course of 7.9 years. DII scores were calculated based on Semi-Quantitative Food-Frequency Questionnaire (SQ-FFQ) data for 106 food items. Cancers were …

Understanding And Use Of Food Labeling Systems Among Whites And Latinos In The United States And Among Mexicans: Results From The International Food Policy Study, 2017, Claudia Nieto, Alejandra Jauregui, Alejandra Contreras-Manzano, Edna Arillo-Santillan, Simon Barquera, Christine M. White, David Hammond, Jim Thrasher

Faculty Publications

Background Obesity and chronic diseases could be prevented through improved diet. Most governments require at least one type of food labeling system on packaged foods to communicate nutrition information and promote healthy eating. This study evaluated adult consumer understanding and use of nutrition labeling systems in the US and Mexico, the most obese countries in the world.

Methods Adults from online consumer panels in the US (Whites n = 2959; Latinos n = 667) and in Mexico (n = 3533) were shown five food labeling systems: 1. Nutrition Facts Table (NFT) that shows nutrients of concern per serving; 2. Guideline …

Addressing The Surgical Deficit: A Global Imperative For Plastic And Reconstructive Surgeons, Rachel W. Davis, Walter D. Johnson, Larry H. Hollier

Faculty Publications

Despite poor access to quality surgical and anesthesia care for the majority of the world's people, with greatest impact on low- and middle-income countries, surgery has only recently begun to gain acceptance as a necessary component of global health. As a leader in global surgical funding, the field of Plastic and Reconstructive Surgery is uniquely positioned to influence change in global policy and financial support. For improvements in surgical access and outcomes worldwide, investment in surgical systems, commitment to national surgery, obstetric, and anesthesia planning, and continued evaluation and improvement of care delivery should be pursued.

Associations Among Neighborhood Socioeconomic Deprivation, Physical Activity Facilities, And Physical Activity In Youth During The Transition From Childhood To Adolescence, Morgan N. Clennin, Min Lian, Natalie Colabianchi, Andrew Kaczynski, Marsha Dowda, Russell R. Pate

Faculty Publications

Background: This study aims to examine the longitudinal association of neighborhood socioeconomic deprivation (SED) with physical activity in youth during the transition from elementary to middle school, and to determine if access to physical activity facilities moderates this relationship. Methods: Data were obtained from the Transitions and Activity Changes in Kids (TRACK) study, which was a multilevel, longitudinal study designed to identify the factors that influence changes in physical activity as youth transition from elementary to middle school. The analytic sample for the current study included 660 youth with complete data in grades 5 (baseline) and 7 (follow-up). A repeated …

The Household Water Insecurity Experiences (Hwise) Scale: Development And Validation Of A Household Water Insecurity Measure For Low-Income And Middle-Income Countries, Sera L. Young, Godfred O. Boateng, Zeina Jamaluddine, Joshua D. Miller, Edward A. Frongillo, Torsten B. Neilands, Shaleans M. Collins, Amber Wutich, Wendy E. Jepson, Justin Stoler

Faculty Publications

Objective Progress towards equitable and sufficient water has primarily been measured by population-level data on water availability. However, higher-resolution measures of water accessibility, adequacy, reliability and safety (ie, water insecurity) are needed to understand how problems with water impact health and well-being. Therefore, we developed the Household Water InSecurity Experiences (HWISE) Scale to measure household water insecurity in an equivalent way across disparate cultural and ecological settings.

Methods Cross-sectional surveys were implemented in 8127 households across 28 sites in 23 low-income and middle-income countries. Data collected included 34 items on water insecurity in the prior month; socio-demographics; water acquisition, use …