Epidemiology Commons^™

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 …

Assessing And Advancing Pandemic Emergency Preparedness In New York City's Hospitals: A Strategic Management Toolkit Integrating Policy Analysis, Risk Assessment, And Stakeholder Insight, Irrem Jamal

College of Graduate Studies: Theses & Dissertations

This dissertation examines pandemic emergency preparedness in New York City hospitals, which were severely strained during COVID-19, revealing critical gaps between documented plans and operational readiness. Using a multimethod approach combining a survey of 20 stakeholders across city hospitals, semi-structured interviews, and document analysis of policy frameworks and after-action reports, the study identifies a persistent "documentation-execution paradox": while 80% of respondents confirmed clear pandemic plans, only 45% expressed confidence in staffing adequacy, 55% in surge planning realism, and just 45% confirmed regular drills. Qualitative analysis revealed workforce as the single greatest yet most underinvested vulnerability, supply chain fragility rooted in …

Trends Among Suspected Opioid Overdose Emergency Medical Service (Ems) Incidents In Georgia From 2019-2023, Ashton Harris

College of Graduate Studies: Theses & Dissertations

Opioid overdoses remain a problem in the United States, underscoring the need for additional surveillance tools to monitor trends in opioid overdoses. Emergency Medical Services (EMS) data is a timely surveillance method that captures more potential overdoses than hospitals by representing the pre-hospital setting. Research questions in the study assess EMS responses to suspect opioid overdose incidents from 2019-2023 in Georgia to encompass the following characteristics: timeframe (pre, during, post-pandemic), urban versus rural counties, race/ethnicity, categorical type of first responder, mean dosage of naloxone in milligrams administered, and death. 84,359 records meeting the inclusion criteria were initially retrieved from the …

Targets To Increase Hiv Pre-Exposure Prophylaxis (Prep) Uptake Among Communities In Northeast Georgia, Kaley E. Parchinski, Molly Hirsh, Andrew Cheng, Nia Kalifa, Manvi Manyam

Journal of the Georgia Public Health Association

Background: This study seeks to identify targets to increase HIV pre-exposure prophylaxis (PrEP) uptake in Athens-Clarke County, GA, a non-urban area with high HIV burden and poor PrEP utilization.

Methods: A cross sectional survey of adults attending HIV outreach screenings in Athens, GA between November 2022 and March 2023 describes participant demographics and validated scales measuring PrEP knowledge, attitudes, stigma, descriptive norms, and intentions.

Results: Of 136 total participants, key demographic groups included Black (N=84, 61.8%), Latinx (N=10, 8.1%), LGBTQ+ (N=25, 18.4%), and persons who use injection drugs (N=19, 15%); overall, less than half of the PrEP knowledge items were …

Perspectives Of African American And Hispanic/Latino Individuals On Hiv Molecular Cluster Detection, Maxwell Richardson, Brendan H. Pulsifer, Jane Yoon Scott, David Holland, Eleanor W. Garlow, Pascale Wortley, Daniel Mauck, Jenna Gettings, Valeria Cantos, Masonia Traylor, Eric Rangel, David Folkes, Carlos Saldana

Journal of the Georgia Public Health Association

Background: Responding to HIV clusters detected using molecular data has been shown to reduce transmission and improve testing, treatment, and prevention. However, there are varied opinions about the use of cluster detection activities, and some advocates have raised concerns about patient consent, data security, and the potential for HIV criminalization. Incorporating the perspectives of marginalized populations that are disproportionately affected by HIV is essential to understanding the diversity of those perspectives, yet it is often overlooked in the literature. Thus, our study seeks to highlight the perspectives of Black/African American and Hispanic/Latino individuals in the Southern United States on HIV …

Associations Between Atmospheric Ozone, Pm2.5 And Prevalence Of Diabetes In Georgia, United States, Kingsley A. Kalu, Jingjing Yin, Atin Adhikari

Journal of the Georgia Public Health Association

Objective:

This study examines the association between two air pollutants (PM_2.5 and ozone), and the prevalence of adult diabetes mellitus in relation to various confounding factors.

Methods:

We collected diabetes prevalence data from the 2015 County Health Ranking and Georgia Health Data Hub. A negative binomial regression analysis was conducted to examine the associations between the county-level dependent variable “adult diabetes” (for adults aged> 18 years diagnosed with Type 1 and Type 2 diabetes) and two independent county-level variables: percentage of days ³ NAAQS for ozone and PM_2.5 concentration levels while controlling for confounders.

Results:

At the county …

93rd Annual Georgia Public Health Association Meeting And Conference Report, Jimmie H. Smith Jr, Angela Peden, Patrina L. Bowles

Journal of the Georgia Public Health Association

The 93^rd Annual Meeting and Conference of the Georgia Public Health Association (GPHA) was held in Jekyll Island, Georgia, at the Jekyll Island Convention Center, on May 3-5, 2023. The goal of the 2023 Georgia Public Health Association Annual Meeting and Conference was to assemble emerging public health professionals, current practitioners, academicians, governing entities, and community stakeholders for educational opportunities and networking to support the vision and mission of GPHA.

The theme for the 2023 Georgia Public Health Association Annual Meeting and Conference theme was selected by the GPHA Executive Board during a meeting in the early fall of …

Pregnancy-Related Maternal Deaths In The State Of Georgia According To Timing And Causes Of Death, Anthony Kondracki, Wei Li, Mitch Mokhtari, Bhuvaneshwari Muchandi, John A. Ashby, Jennifer L. Barkin

Georgia Public Health Association Annual Meeting & Conference

BACKGROUND: This study examines pregnancy-related maternal deaths in the State of Georgia according to timing and causes of death in association with maternal sociodemographic characteristics. METHODS: Maternal mortality data from 2016 to 2019 were obtained from the Georgia Department of Public Health and the study sample was restricted to pregnancy-related deaths. Descriptive analyses compared timing and six leading underlying causes of maternal death in association with basic sociodemographic characteristics. A distribution of the leading underlying causes of death was conducted among the four time-points, i.e., during pregnancy, 0 to 60 days, 61 to 180 days, and 181 to 365 days …

"Shut Down And Closed Off": A Routine Activity Approach To Investigating The Relationship Between Covid-19 School Closures And Child Sexual Abuse Report Characteristics In Georgia, Spencer E. Riner

College of Graduate Studies: Theses & Dissertations

The COVID-19 pandemic of 2020 created a public health crisis that led to an unprecedented number of school closures. A major concern raised by child advocates, law enforcement, and social service providers was the possible increase in undetected child abuse and maltreatment. Undergirding this concern was the belief that this mitigation effort might place child abuse victims and offenders within proximity for extended periods of time. While this was a significant concern, it has rarely been analyzed empirically. To address this gap in the literature, this thesis investigates how school closures impacted the characteristics of child sexual abuse (CSA) reports …

Factors Associated With Hepatitis C-Related Hospitalizations And Inpatient Mortality In The United States, Pre- And Post-Onset Of The Covid-19 Pandemic, Christina R. Samuel

College of Graduate Studies: Theses & Dissertations

Background: Hepatitis C is a significant public health problem in the United States and imposes a substantial burden on the healthcare system. Previous research shows that the COVID-19 pandemic response efforts have overshadowed hepatitis C testing and treatment measures in health care settings across the country. The purpose of this study was to describe and examine the factors associated with hepatitis C-related hospitalizations and inpatient mortality in the United States, pre- and post-onset of the COVID-19 pandemic. Methods: Data were obtained from the 2019-2020 National Inpatient Sample database. The study population included persons aged ≥18 years with hepatitis C-related inpatient …

History And Current Status Of Mediterranean Spotted Fever (Msf) In The Crimean Peninsula And Neighboring Regions Along The Black Sea Coast, Muniver T. Gafarova, Marina E. Eremeeva

Biostatistics, Epidemiology & Environmental Health Sciences: Faculty Publications

Mediterranean spotted fever (MSF) is a tick-borne rickettsiosis caused by Rickettsia conorii subspecies conorii and transmitted to humans by Rhipicephalus sanguineus ticks. The disease was first discovered in Tunisia in 1910 and was subsequently reported from other Mediterranean countries. The first cases of MSF in the former Soviet Union were detected in 1936 on the Crimean Peninsula. This review summarizes the historic information and main features of MSF in that region and contemporary surveillance and control efforts for this rickettsiosis. Current data pertinent to the epidemiology of the disease, circulation of the ticks and distribution of animal hosts are discussed …

The Public Health Impact Of Paxlovid Covid-19 Treatment In The United States, Yuan Bai, Zhanwei Du, Lin Wang, Eric H. Y. Lau, Isaac Fung, Petter Holme, Ben Cowling, Alison Galvani, Robert Krug, Lauren Ancel Meyers

Biostatistics, Epidemiology & Environmental Health Sciences: Faculty Publications

The antiviral drug Paxlovid has been shown to rapidly reduce viral load. Coupled with vaccination, timely administration of safe and effective antivirals could provide a path towards managing COVID-19 without restrictive non-pharmaceutical measures. Here, we estimate the population-level impacts of expanding treatment with Paxlovid in the US using a multi-scale mathematical model of SARS-CoV-2 transmission that incorporates the within-host viral load dynamics of the Omicron variant. We find that, under a low transmission scenario (Re∼1.2) treating 20% of symptomatic cases would be life and cost saving, leading to an estimated 0.26 (95% CrI: 0.03, 0.59) million hospitalizations averted, 30.61 (95% …

Characteristics And Source-Specific Health Risks Of Ambient Pm2.5-Bound Pahs In An Urban City Of Northern Taiwan, Yu-Chieh Ting, Chun-Hung Ku, Yu-Xuan Zou, Kai-Hsien Chi, Jhy-Charm Soo, Chin-Yu Hsu, Yu-Cheng Chen

Biostatistics, Epidemiology & Environmental Health Sciences: Faculty Publications

Polycyclic aromatic hydrocarbons (PAHs) with highly toxic compounds mainly exist in small-sized particles and can induce considerable human health risks. Studies on PM2.5-bound PAHs and their source-specific human health risks still remain scarce. Daily PM2.5 samples (n = 119) were collected every three days from 2016 to 2017 in Taipei city, Taiwan. Fifteen PAHs in PM2.5 were analyzed via gas chromatography tandem mass spectrometry (GC/MS-MS). We utilized a positive matrix factorization (PMF) model, diagnostic ratios, and potential source contribution function (PSCF) to identify the origins of PM2.5-bound PAHs. The annual concentration of total PAHs (TPAH) was 0.79 ± 0.67 ng …

Exposure Levels Of Airborne Fungi, Bacteria, And Antibiotic Resistance Genes In Cotton Farms During Cotton Harvesting And Evaluations Of N95 Respirators Against These Bioaerosols, Atin Adhikari, Pratik Banerjee, Taylor Thornton, Daleniece Higgins, Caleb Adeoye, Sonam Sherpa

Biostatistics, Epidemiology & Environmental Health Sciences: Faculty Publications

The USA is the third-leading cotton-producing country worldwide and cotton farming is common in the state of Georgia. Cotton harvest can be a significant contributor to airborne microbial exposures to farmers and nearby rural communities. The use of respirators or masks is one of the viable options for reducing organic dust and bioaerosol exposures among farmers. Unfortunately, the OSHA Respiratory Protection Standard (29 CFR Part 1910.134) does not apply to agricultural workplaces and the filtration efficiency of N95 respirators was never field-tested against airborne microorganisms and antibiotic resistance genes (ARGs) during cotton harvesting. This study addressed these two information gaps. …

Childhood Asthma-Management Practices In Rural Nigeria: Exploring The Knowledge, Attitude, And Practice Of Caregivers In Oyo State, Oyindamola Akinso, Atin Adhikari, Jingjing Yin, Joanne Chopak-Foss, Gulzar H. Shah

Biostatistics, Epidemiology & Environmental Health Sciences: Faculty Publications

Background: Caregivers of asthmatic children have a poor knowledge of proper asthma-management practices in Nigeria. This study examined the knowledge, attitudes, and practice behaviors of caregivers in the management of asthma in children under 5 years of age in Oyo State, Nigeria. Methods: While a mixed method was used in the original research, this brief describes the quantitative method used in this study to evaluate caregivers’ asthma-management practices. A 55-item questionnaire on childhood asthma knowledge, attitude, and practice was administered during child welfare-clinic visits to 118 caregivers. Data were analyzed using the IBM SPSS Version 25.0. Statistical significance was set …

Please Romaine Calm! A Multi-Disciplinary Investigation Of A Cyclospora Outbreak Among Hospital Employees, Jocelyn Love Mph, Amber Erickson Drph, Mph, Hope Dishman Mph, Carla Coley Bs, Rehs

Georgia Public Health Association Annual Meeting & Conference

Background

On July 8, 2022, North Central Health District (NCHD) was notified by a local hospital of a possible Cyclospora outbreak among hospital employees. The hospital noted the employees had eaten at the hospital’s cafeteria, particularly the salad bar. An investigation was conducted to test this hypothesis and determine which salad bar ingredients were the cause of illness.

Methods

An electronic survey was shared with all hospital employees through their email distribution system. Employees were asked to complete the survey regardless of illness or exposure history. Lab- confirmed cases were interviewed using the Cyclosporiasis National Hypothesis Generating Questionnaire. Environmental health …

On Cox Proportional Hazards Model Performance Under Different Sampling Schemes, Hani Samawi, Lili Yu, Jingjing Yin

Biostatistics, Epidemiology & Environmental Health Sciences: Faculty Publications

Cox’s proportional hazards model (PH) is an acceptable model for survival data analysis. This work investigates PH models’ performance under different efficient sampling schemes for analyzing time to event data (survival data). We will compare a modified Extreme, and Double Extreme Ranked Set Sampling (ERSS, and DERSS) schemes with a simple random sampling scheme. Observations are assumed to be selected based on an easy-to-evaluate baseline available variable associated with the survival time. Through intensive simulations, we show that these modified approaches (ERSS and DERSS) provide more powerful testing procedures and more efficient estimates of hazard ratio than those based on …

A Pharmacoepidemiological Study Of Myocarditis And Pericarditis Following The First Dose Of Mrna Covid-19 Vaccine In Europe, Joana Tome, Logan Cowan, Isaac Fung

Biostatistics, Epidemiology & Environmental Health Sciences: Faculty Publications

This study assessed the myocarditis and pericarditis reporting rate of the first dose of mRNA COVID-19 vaccines in Europe. Myocarditis and pericarditis data pertinent to mRNA COVID19 vaccines (1 January 2021–11 February 2022) from EudraVigilance database were combined with European Centre for Disease Prevention and Control (ECDC)’s vaccination tracker data. The reporting rate was expressed as events (occurring within 28 days of the first dose) per 1 million individuals vaccinated. An observed-to-expected (OE) analysis quantified excess risk for myocarditis or pericarditis following the first mRNA COVID-19 vaccination. The reporting rate of myocarditis per 1 million individuals vaccinated was 17.27 (95% …

Knowledge, Attitude, And Behavioral Intention About Oral Cancer Among Public Health Students In Southeast Georgia, Ravneet Kaur, Gulzar H. Shah

Biostatistics, Epidemiology & Environmental Health Sciences: Faculty Publications

Background: Oral cancer (OC) is a significant public health problem; however, the degree to which the future public health workforce is aware of this issue is not well researched. The purpose of this study is to explore the level of knowledge, attitudes, and behavioral intentions about OC among public health students.
Materials and Methods: A sequential exploratory mixed-method research design was employed for this study. Using quantitative and qualitative measures, a survey was administered to 129 public health students. Subsequently, to understand the quantitative findings, two follow-up focus groups were conducted with survey participants.
Results: We found …

Hospitalizations And Mortality ​With Alzheimer’S Disease And Related Dementias Diagnosis In Georgia, 2020, Chloe Hale

Georgia Public Health Association Annual Meeting & Conference

More than 6 million Americans aged 65 and older are living with an Alzheimer’s disease or related dementia diagnosis (ADRD) in 2022. Data from the 2019 Behavioral Risk Factor Surveillance System report that in Georgia, 1 in 9 people aged 45 and older experienced confusion or memory problems that have been getting worse over the past year.

Georgia Department of Public Health Injury Prevention Program creates a healthy Georgia through conversations and collaborations for change using data driven program building. The programs utilize Georgia’s established infrastructure, clear priorities, and the dynamic network of partnerships guided by a robust network of …

Addressing Breast Health Disparities Among Recent, Established African-Born Immigrant Women And Second-Generation Americans In Prince George County, Maryland, Omolola Okunromade

College of Graduate Studies: Theses & Dissertations

Background: Breast health disparities and underutilization of screening methods are major concerns in the United States (US), particularly affecting Black women who experience lower survival rates and advanced diagnoses. Despite the rapid growth of the African-born immigrant population, breast health among this group in the US is notably under-examined. This study aims to investigate the breast health knowledge and practices of first-generation African-born immigrants and second-generation immigrant women of African descent, aiming to understand the distinctive attributes of this group and the impact of acculturation on this public health issue.

Methods: Interviews were conducted among First Generation African immigrants and …

Turnover, Covid-19, And Reasons For Leaving And Staying Within Governmental Public Health, Jonathan P. Leider, Gulzar H. Shah, Valerie A. Yeager, Jingjing Yin, Kusuma Madamala

Biostatistics, Epidemiology & Environmental Health Sciences: Faculty Publications

Background and Objectives:

Public health workforce recruitment and retention continue to challenge public health agencies. This study aims to describe the trends in intention to leave and retire and analyze factors associated with intentions to leave and intentions to stay.

Design:

Using national-level data from the 2017 and 2021 Public Health Workforce Interests and Needs Surveys, bivariate analyses of intent to leave were conducted using a Rao-Scott adjusted chi-square and multivariate analysis using logistic regression models.

Results:

In 2021, 20% of employees planned to retire and 30% were considering leaving. In contrast, 23% of employees planned to retire and 28% …

On Kernel-Based Estimator Of Odds Ratio Using Different Stratified Sampling Schemes, Abbas Eftekharian, Hani Samawi, Haresh Rochani

Biostatistics, Epidemiology & Environmental Health Sciences: Faculty Publications

The kernel-based estimator of Cochran Mantel-Haenszel odds ratio based on stratified simple and ranked set sampling is proposed. The expectation and variance of the estimator are analytically obtained. Using a simulation study, the estimator based on stratified ranked set sampling is more efficient than its counterpart based on stratified simple random sampling. Finally, the estimator's performance is investigated by using base deficit data.

A Bootstrap Method For A Multiple-Imputation Variance Estimator In Survey Sampling, Lili Yu, Yichuan Zhao

Biostatistics, Epidemiology & Environmental Health Sciences: Faculty Publications

Rubin’s variance estimator of the multiple imputation estimator for a domain mean is not asymptotically unbiased. Kim et al. derived the closed-form bias for Rubin’s variance estimator. In addition, they proposed an asymptotically unbiased variance estimator for the multiple imputation estimator when the imputed values can be written as a linear function of the observed values. However, this needs the assumption that the covariance of the imputed values in the same imputed dataset is twice that in the different imputed datasets. In this study, we proposed a bootstrap variance estimator that does not need this assumption. Both theoretical argument and …

Association Between The Health Belief Model, Exercise, And Nutrition Behaviors During The Covid-19 Pandemic, Keagan Kiely, Bill Mase, Andrew R. Hansen, Jessica S. Schwind

Biostatistics, Epidemiology & Environmental Health Sciences: Faculty Publications

Introduction: The COVID-19 pandemic has affected our nation’s health further than the infection it causes. Physical activity levels and dietary intake have suffered while individuals grapple with the changes in behavior to reduce viral transmission. With unique nuances regarding the access to physical activity and nutrition during the pandemic, the constructs of Health Belief Model (HBM) may present themselves differently in nutrition and exercise behaviors compared to precautions implemented to reduce viral transmission studied in previous research. The purpose of this study was to investigate the extent of exercise and nutritional behavior change during the COVID-19 pandemic and explain the …

Pandemic Fatigue Impedes Mitigation Of Covid-19 In Hong Kong, Zhanwei Du, Lin Wang, Songwei Shan, Dickson Lam, Tim K. Tsang, Jingyi Xiao, Huizhi Gao, Bingyi Yang, Sheikh Taslim Ali, Sen Pei, Isaac Chun-Hai Fung, Eric H. Y. Lau, Qiuyan Liao, Peng Wu, Lauren Ancel Meyers, Gabriel M. Leung, Benjamin Cowling

Biostatistics, Epidemiology & Environmental Health Sciences: Faculty Publications

Hong Kong has implemented stringent public health and social measures (PHSMs) to curb each of the four COVID-19 epidemic waves since January 2020. The third wave between July and September 2020 was brought under control within 2 m, while the fourth wave starting from the end of October 2020 has taken longer to bring under control and lasted at least 5 mo. Here, we report the pandemic fatigue as one of the potential reasons for the reduced impact of PHSMs on transmission in the fourth wave. We contacted either 500 or 1,000 local residents through weekly random-digit dialing of landlines …

Release Of Vocs, Gasses, And Bacteria From Contaminated Landings And Creeks Of Ogeechee River Basin, Victoria A. Clower, Melanie Sparrow, Atin Adhikari

Biostatistics, Epidemiology & Environmental Health Sciences: Faculty Publications

River landings are common public grounds, visited by many people every day. The aftermath of visiting these places may be unsettling since much trash is left behind and scattered throughout. The litter collects and with each rain or high wind, it has a better chance of ending up in our streams, rivers, creeks, and eventually our oceans. The main purpose of this study was to measure both air and water quality throughout the Ogeechee River basin in South Georgia to determine how each was impacted by trash. Ammonia, methane, and volatile organic compounds (VOCs) along with temperature and humidity were …

Respiratory, Neurological And Other Health Outcomes Among Plastic Factory Workers In Gazipur, Bangladesh, Shobhan Das, Md. Masudur Rahman, Asmaul Husna, Margia Akter, Md. Matiur Rahaman, Md. Taohidul Islam, Md. Jamal Uddin, Atin Adhikari

Biostatistics, Epidemiology & Environmental Health Sciences: Faculty Publications

Background: Approximately three thousand plastic goods manufacturing factories (PGMF) are currently operating in Bangladesh involving numerous workers. Associated health problems of these workers are largely unknown. The key objectives of the current study were identifying plastic chemical exposures related health outcomes in these workers and comparing these outcomes before and after their joining in PGMFs. In addition, we aimed to investigate the relationships between work duration and the prevalence of health ailments among workers.

Method: A cross-sectional study was carried out among factory workers (n=405) at six PGMFs in Gazipur district in Bangladesh. A simple random sampling method had been …

Air Pollutant Levels And Asthma Emergency Room Visits In A Highly Populous Us Urban County During 2018-19, Osaremhen Ikhile, Jingjing Yin, Atin Adhikari

Biostatistics, Epidemiology & Environmental Health Sciences: Faculty Publications

Objective: Air pollutants are linked to asthma exacerbation. The study purpose was to demonstrate an association between air pollutants levels and asthma emergency room (ER) visit trends in a highly populated US urban county in Georgia during 2018-2019.

Methods: Time series analyses were conducted for the variations in daily numbers of children and adult asthma emergency room visits and changes in daily mean PM_2.5, daily mean PM₁₀ concentrations, daily max 1-hour SO₂ concentrations, daily max 1-hour NO₂ concentrations, daily max 8-hour ozone concentrations, and airborne pollen loads for 2018 to 2019 and potential trends were …

Transmission Dynamics Of Covid-19 In Ghana And The Impact Of Public Health Interventions, Sylvia Ofori, Jessica S. Schwind, Kelly L. Sullivan, Benjamin J. Cowling, Gerardo Chowell, Isaac Fung

Biostatistics, Epidemiology & Environmental Health Sciences: Faculty Publications

This study characterized COVID-19 transmission in Ghana in 2020 and 2021 by estimating the time-varying reproduction number (Rt) and exploring its association with various public health interventions at the national and regional levels. Ghana experienced four pandemic waves, with epidemic peaks in July 2020 and January, August, and December 2021. The epidemic peak was the highest nationwide in December 2021 with Rt ≥ 2. Throughout 2020 and 2021, per-capita cumulative case count by region increased with population size. Mobility data suggested a negative correlation between Rt and staying home during the first 90 days of the pandemic. The …