Epidemiology Commons^™

Surveillance And Comparative Genomics Of Bacteria From Hospital And Human Reservoirs, Emily E. Benedict

WUSM Theses and Dissertations – All Programs

Bacteria are diverse and adaptable and, consequently, present in a wide variety of environments. They are capable of growing under intense pressures, including those brought on by the human immune system and disinfection strategies. To survive these pressures, bacteria develop resistances. Antimicrobial resistance, which occurs when a microbe is no longer responsive to the antibiotic intended to control it, is one such adaptation that presents an especially serious threat, as it limits treatment options for infections caused by antimicrobial resistant microbes. Similarly, the ability of bacteria to survive in environments subjected to heavy disinfection efforts, such as intensive care units …

Faktor-Faktor Yang Berhubungan Dengan Kepatuhan Minum Obat Anti Tuberkulosis (Oat) Di Kota Samarinda, Fahmi Nur Indah Sari, Irfansyah Baharuddin Pakki, Nur Rohmah, Siswanto Siswanto, Muhamad Z. Saefurrohim

Jurnal Epidemiologi Kesehatan Indonesia

Latar Belakang: Tuberkulosis (TB) merupakan penyakit menular yang masih menjadi masalah kesehatan masyarakat utama di Indonesia. Keberhasilan pengobatan sangat bergantung pada kepatuhan pasien dalam mengonsumsi Obat Antituberkulosis (OAT) .

Tujuan . Untuk mengetahui hubungan antara persepsi kerentanan, keparahan, manfaat, hambatan (stigma), isyarat untuk bertindak (peran tenaga kesehatan), dan efikasi diri dengan kepatuhan minum OAT pada pasien TB di Kota Samarinda.

Metode . Penelitian ini menggunakan desain potong lintang dengan pendekatan kuantitatif yang melibatkan 121 pasien TB dari empat Puskesmas di Samarinda. Sampel dipilih menggunakan teknik multistage sampling. Data dikumpulkan melalui wawancara terstruktur menggunakan kuesioner dan dianalisis menggunakan uji Chi-Square.

Hasil …

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

Jurnal Epidemiologi Kesehatan Indonesia

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

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

Journal of Extension

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

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

Kesmas

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

Healthcare Access And The Persistent Racial Disparities In Low Birth Weight, Zaheda A. Hussain, Yadanar Moe

DePaul Discoveries

Low birth weight (LBW), defined as less than 2,500 grams, is an influential factor contributing to infant mortality in the United States, with significant racial disparities between Black and White mothers. This study analyzed data from 3,054 Black and White mothers collected from the 2018 National Health Interview Survey to explore the association between access to medical care and LBW within different racial groups. The prevalence of LBW was 8.0%. Overall, mothers without a usual place of medical care had, on average, an 18% higher risk of LBW than those with a usual place (OR = 1.18, 95% CI: 0.80–1.74). …

Analysis Of Priority Vaccine-Preventable Diseases Using The Paho-Adapted Hanlon Method In Bogor City In 2024, Sonia Annisa Br Ketaren, Tri Yunis Miko Wahyono, Bai Kusnadi

Jurnal Epidemiologi Kesehatan Indonesia

Vaccine-preventable diseases (VPDs) remain a major public health challenge despite substantial progress in immunization programs. In Indonesia, routine immunization coverage has shown a post-pandemic recovery trend; however, disparities in access to health services and surveillance quality persist across regions. This study aimed to determine priority VPD problems in Bogor City and identify factors contributing to the highest-ranked disease. A mixed-methods study was conducted in Bogor City from October 2024 to January 2025. Quantitative prioritization was performed using the Pan American Health Organization (PAHO)-adapted Hanlon method across eight VPDs. Qualitative data were collected through in-depth interviews with key informants and analyzed …

Association Of Household Economic Status And Birth Order With Stunting Among Children Aged 24-35 Months: Malawi Mics 2019–20, Sibongire B. Ngoma, Asri C. Adisasmita, Renti Mahkota, Septyana Choirunisa, Melisa Nyamukondiwa

Jurnal Epidemiologi Kesehatan Indonesia

Stunting remains a major public health concern in Malawi, with a national prevalence of 35.5% among children under five. However, evidence on the independent and combined effects of household economic status and birth order on stunting among Malawian children aged 24-35 months remains limited. This study aimed to examine the independent and combined association of household economic status and birth order with stunting among children aged 24-35 months in Malawi. A secondary data analysis of a cross-sectional 2019-20 Malawi Multiple Indicator Cluster Survey (MICS) was conducted, and the final sample comprised 2,764 children aged 24-35 months with complete data. Stunting …

Urban-Rural Differences In The Association Between Physical Activity And Overweight/Obesity Among Indonesian Adolescents: A Cross-Sectional Study, Wahyu Wulandari, Mufti As Siddiq M. Irzal, Lady Farah Fatmawati

Jurnal Epidemiologi Kesehatan Indonesia

Adolescent overweight/obesity is an increasing public health concern and contributes to the risk of non-communicable diseases later in life. Physical activity plays an important role in weight regulation. However, its association with overweight/obesity may vary according to residential setting. This study aimed to examine the association between physical activity and overweight/obesity among adolescents living in rural and urban areas of Indonesia. A cross-sectional study was conducted using data from the 2023 Indonesian Health Survey. The study included 115,372 adolescents aged 10–18 years. Physical activity was classified based on total Metabolic Equivalent of Task (MET)-minutes per week (≥600 MET-minutes/week), while nutritional …

Epidemiology And Ultrasonographic Observations Of Urogenital Schistosomiasis Related Urinary Tract Morbidity In Itilima District, Simiyu Region, Tanzania, Coletha Yohana, Bruno A. Nyundo, Jared S. Bakuza, Peter F. Rambau, Safari M. Kinung’Hi

Tanzania Journal of Science

Chronic infection of urogenital schistosomiasis in humans is a major cause of urinary tract morbidity in endemic areas. However, information on the prevalence of schistosomiasisrelated urinary tract morbidity is lacking in most endemic countries including Tanzania. This study was conducted to determine the prevalence of schistosomiasis-related urinary tract morbidity in schoolchildren and adults in Itilima District. Urine samples from 682 residents were examined for Schistosoma haematobium infection using urine filtration technique. Urinary tract morbidity was examined by ultrasound. The prevalence of S. haematobium infection was 16.4% (112/682) and varied significantly between villages (range 3.2% to 29.5%, χ2 = 48.467, p < 0.001). There was no significant variation of S. haematobium infection between male and female (8.3 % vs 8.1%, χ2 = 0.679, p = 0.410). Majority (93.8%) had light infections (

A Predictive Coding Account Of Spatial Working Memory Following Prophylactic Levetiracetam Administration Prior To Traumatic Brain Injury, Omeima Mutwali

Dissertations, Theses, and Capstone Projects

Traumatic brain injury (TBI) symptom prevention and remediation is an important area of research that would benefit vulnerable groups, including active-duty and veteran soldiers. These patients can sustain penetrative forces in fields of combat or in training, which result in focal lesions that trigger inflammatory and degenerative processes in the brain. Both primary and secondary injuries are associated with changes to cognition, behavior and affective state. This disease poses increased risk of epileptogenesis, as well. Given these outcomes, prior research has evaluated levetiracetam (LEV) as a prophylactic treatment for seizures, cognitive deficits and negative emotionality. LEV acts as a presynaptic …

Intervention Levers For Stunting Reduction In Indonesia: Evidence From The 2023 Indonesian Health Survey Data, Iwan Ariawan, Hafizah Jusril, Zahra Izza Afifa, Azka Fitri, Elmarizha Sekar Utami, Mikail Hasan, Dwi Puspasari

Kesmas

Stunting remains the largest public health challenge among macro-nutrition problems in Indonesia, affecting almost a quarter of children under five in 2023. The prevalence is considered high according to the World Health Organization standard. This study analyzed 15 aggregated provincial variables from the 2023 Indonesian Health Survey using Structural Equation Modeling (SEM), focusing on determinants of stunting among children under two to identify primary intervention levers. Findings indicated that intervention urgency should focus on the first 1,000 days, particularly the steep increase in stunting prevalence observed in the 12–24-month age range. While the highest prevalence is in Eastern provinces (e.g., …

Psychosocial Mediators Of A Physical Activity And Dietary Intervention In Pregnant Women With Overweight Or Obesity, Meghan Baruth, Sarah Wilcox, Jihong Liu, Rebecca Schlaff

Faculty Publications

Background

Mediation analyses provide insight into both ‘pieces’ of the mediation chain; they allow us to look into the ‘black box’ that is behavior change. They allow researchers to better understand the ‘how’ of an intervention’s effects and/or the ‘why’ behind why an intervention worked or did not work. The lack of publications in pregnant populations highlights the need for additional studies to be conducted and published. The purpose of this study is to examine the psychosocial mediators of physical activity and dietary outcomes in a sample of pregnant women with overweight or obesity participating in the Health in Pregnancy …

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 …

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. …

Impact Of Statin Medication Use On Glycemic Control And Complications In Type 1 Diabetes, Ryan Bailey

USF Tampa Graduate Theses and Dissertations

Introduction: Hydroxymethylglutaryl-CoA enzyme inhibitors (statins) are frequently used to prevent cardiovascular events in individuals at high risk for cardiovascular diseases, including individuals with diabetes. Prior research has indicated that statins may increase the risk of developing type 2 diabetes (T2D) and may increase hyperglycemia among those previously diagnosed with T2D. To date, little research has investigated the impact of statins on glycemic control and diabetic complications associated with poor glycemic control in those with type 1 diabetes (T1D). The objective of this dissertation is to investigate the association between statin use and measures of glycemic control including hemoglobin A1c (HbA1c), …

Muscular Fitness Levels Of U.S. Children And Adolescents, Daniel J. Mcdonough, Yong Gao, Lynda B. Ransdell, Haichun Sun

International Journal of Physical Activity and Health

Purpose: To describe muscular fitness (MF) levels and percentile benchmarks among U.S. children and adolescents aged 6–15 years old across sociodemographic, physiological, and behavioral subgroups. Methods: Data were from the 2012 NHANES National Youth Fitness Survey (NNYFS). Four strength tests consisting of the plank, knee extension, modified pull-up, and handgrip, were analyzed by age, sex, race/ethnicity, income, BMI category, cardiorespiratory fitness (CRF), and physical activity (PA) among 1,234 participants (51% male) using SAS SURVEY procedures. Results: Mean ± SEM scores were 69.6 ± 1.8 s (plank), 56.6 ± 4.2 lb (left) and 59.2 ± 4.3 lb (right) knee extension, 5.5 …

Ecologic Factors Contributing To West Nile Virus Hyperendemicity In Central South Carolina: An Integrated Vector–Human–Environmental Study, Elba S. Fridriksson, Ahayla Muraleedharan, Kyndall C. Dye-Braumuller, Madeleine M. Meyer, Kia Zellars, Hiuxuan Li, Melissa S. Nolan Ph.D., Mph

Faculty Publications

West Nile virus (WNV) is an endemic arboviral infection in the United States that has undergone phyloge-netic evolution since its introduction 25 years ago. An integrated vector–human–pathogen study was conducted in the summer of 2023 to unearth contemporary Culex quinquefasciatus habitat patterns and human transmission spillover foci in South Carolina, a state with historically little WNV data. A serosurvey revealed WNV seroprevalence 10 times the national average (22% versus 2%, respectively), with unusual epidemiologic risk factors. Female Culex quinquefas-ciatus WNV positivity was low (2.7%), with viral phylogenetics 100% homologous to the WN02 clade. Mosquito vectors clustered in affluent urban neighborhoods …

An Impact Assessment Of The Effectiveness Of Utilizing Informal Health Communication Interventions To Spread Health Recommendations And Change Public Perception, Lina Mohamed Ezzat Ahmed Abdel Mawgoud

Theses and Dissertations

Brain health is an increasingly urgent but critically under-addressed public health priority in Egypt and the wider MENA region. Despite its centrality to aging, productivity, and overall quality of life, public understanding of brain health remains limited, and stigma continues to shape responses to dementia and cognitive decline. This study evaluates the effectiveness of informal, culturally adapted health communication as a tool to shift perception, increase awareness, and promote behavior change among non-medically trained adults in Egypt.

Grounded in global evidence on cognitive reserve, neuroplasticity, and the life-course approach to brain health, the intervention translated expert-informed brain health recommendations into …

Management-Driven Shifts In The Bison Fecal Microbiome And Its Relationship To Stec Prevalence, Ritesh Ray

Graduate Research Theses & Dissertations

Contamination of meat samples from pathogens such as Shiga toxin-producing E. coli (STEC), especially in ruminants, is an ever-growing issue for the safety of global meat production. Recent studies have reported STEC in the livestock and food industry with a limited focus on wildlife. Although cattle serve as the primary reservoir for STEC, American bison (Bison bison bison) is the largest ruminant inhabiting North America, sharing similar genetics, and grazing habits, making them an ideal alternative STEC reservoir. Re-introduction for prairie conservation and meat farming has brought bison herds closer to anthropic environments than before. Recently bison meat has become …

Forecasting Lung Cancer Burden Using Multicenter Real-World Data, Omer Aydin, Levent Korkmaz, Aybeyan Selim, Murat Kuzlu, Ferhat Ozgur Catak, Huseyin Kusetogullari, Umit Cali

Engineering Technology Faculty Publications

Background – Lung cancer continues to place a significant clinical and operational burden on healthcare infrastructure and systems. While essential epidemiological data can be obtained from population-based registries, these systems often fail to provide information on long-term follow-up and healthcare utilization dynamics. Real-world data collected from healthcare institutions offer valuable insights; however, in-depth and careful analysis is necessary to distinguish true diagnostic trends from changes in service utilization and access.

Objectives – The primary objective of this study is to characterize and forecast the prevalence of lung cancer diagnoses at the specified hospitals for future years. The study aims to …

24-H Circadian Rest-Activity Rhythms And Physical Frailty In Older Adults: A Biopsychosocial Perspective On Sex Differences And Social Capital, Jisu Kim

Theses and Dissertations

Physical frailty is a prevalent geriatric syndrome characterized by age-related decline across multiple physiological systems. Physical frailty is associated with an elevated risk of adverse health outcomes, including chronic disease progression and all-cause mortality, representing a significant and growing public health concern. Disrupted circadian rest-activity rhythms (RARs) are increasingly recognized as clinically meaningful markers of physical frailty in older adults. However, the extent to which biological sex and social determinants of health (SDoH), particularly social capital, contribute to or modify the associations between RARs and physical frailty remains underexplored.

Therefore, this dissertation summarizes the existing literature on age-related changes in …

Selenium And Liver Steatosis And Fibrosis: Opposing Direct And Steatosis-Mediated Associations In A Large Cohort, Neda Rehan, Jubilee Benedict, Rehan Qayyum

Department of Medicine Faculty Publications

Background and Aims

Epidemiologic studies have reported conflicting associations between selenium exposure and liver disease. Whether selenium exerts opposing direct and steatosis-mediated effects on liver fibrosis is unknown. To evaluate the associations of blood selenium with elastography-defined hepatic steatosis and fibrosis and to determine whether hepatic steatosis mediates the relationship between selenium and fibrosis.

Methods

We conducted a cross-sectional analysis of adults aged >= 18 years in NHANES 2017-2023. Hepatic steatosis was assessed using the controlled attenuation parameter (CAP) and fibrosis using liver stiffness measurement (LSM). Blood selenium was categorized into quartiles. Survey-weighted multivariable linear regression and structural equation modeling …

Exploring The Impact Of Adverse Childhood Experiences On Preventive Healthcare Utilization In Rural Georgia, Ryan R. Traylor

College of Graduate Studies: Theses & Dissertations

This study examines the relationship between Adverse Childhood Experiences (ACEs) and preventive healthcare use among adults in Georgia, specifically within rural populations facing structural barriers. Using 2023 Georgia Behavioral Risk Factor Surveillance System (BRFSS) data, the research analyzes associations between ACE exposure, rural residence, and preventive care outcomes, including physical exams and flu vaccinations. Guided by an intersectionally adapted version of Andersen’s Behavioral Model of Health Services Use, the study evaluates how predisposing factors, enabling resources, and perceived barriers relate to healthcare engagement. Logistic regression analyses assess the correlation of ACE exposure, cost barriers, provider access, and sociodemographics with preventive …

Prevalence Of Grip And Leg Strength Asymmetries In U.S. Youth, Elyse M. Deschryver

Theses and Dissertations

Early-life physical activity is important for building muscular strength, supporting healthy growth and disease prevention, and for establishing physical activity and strength habits that often track into adulthood. Although grip strength asymmetry is a well-documented risk factor in older adults, evidence in children and adolescents is limited and largely based on small, sport-specific samples. PURPOSE: To describe grip and leg extension strength asymmetries in a nationally representative sample of U.S. youth aged 6–15 years using the National Youth Fitness Survey (NNYFS). METHODS: The analysis included 1,214 participants (606 boys, 608 girls) with valid grip or leg extension data. Age, sex, …

Hubungan Kehamilan Usia Remaja Dengan Kelahiran Prematur Di Rsud Cengkareng Jakarta Barat Tahun 2022: Sebuah Studi Kohort Retrospektif, Anna Triana, Sudarto Ronoatmodjo

Jurnal Epidemiologi Kesehatan Indonesia

Premature birth is leading causes of neonatal mortality. According to the World Health Organization (WHO), global premature birth rates reached 9.9% in 2020, it’s rising compared to preterm birth rates in 2010. One of the risk factors for preterm birth is the mother's age, which pregnant adolescents are more at risk of giving birth to preterm babies due to physiological, psychological, and socioeconomic immaturity. This study is an analytical study with a retrospective cohort design to determine the relationship between adolescents pregnancy and preterm birth. This study was conducted in Cengkareng General Hospital West Jakarta using patient’s medical record data. …

Kejadian Luar Biasa Gondongan Di Sd Islam X Samarinda, 2024, Rudy Agus Riyanto, Irfansyah Baharuddin Pakki, Mela Sabena, Meli Pasiakan, Erlina Erlina, Rima Andriani

Jurnal Epidemiologi Kesehatan Indonesia

Mumps outbreaks are a public health issue that still frequently occur in elementary school settings, particularly among children with low immunization coverage. Therefore, a comprehensive epidemiological understanding is needed as a basis for control. This research aims to describe the epidemiological picture and causative factors of the mumps outbreak that occurred at Islamic Elementary School X in Samarinda City in 2024, using a case series design. The outbreak occurred from April to October 2024, while epidemiological data collection and case verification were conducted from December 2nd to 8th, 2024. The analysis uses surveillance data, field observations, and questionnaires administered to …

Public Perception About Covid-19 Vaccine Hesitancy In South Central Nebraska, Rita Nnenne Oparaocha

Biology Theses, Dissertations, and Student Creative Activity

The COVID-19 pandemic created a shift in the trajectory of vaccination hesitancy, altering risk perceptions and vaccination attitudes among individuals in rural communities. The 5C framework highlights confidence, complacency, constraints, calculation, and collective responsibility as influencing factors of vaccine hesitancy. This study assessed the proportion of adults who refused COVID-19 vaccination and identified the individual reasons for hesitancy among those who refused the COVID -19 vaccines in South Central Nebraska. Data was analyzed from a local cross-sectional public health survey administered to 2,034 adult participants over a six-month period (March-August 2024), including 91 respondents who were from outside the seven-county …