Epidemiology Commons^™

Maternal Occupation And Pediatric Brain Cancer In Kentucky, Mary Begley

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Pediatric brain cancer is a rare and potentially deadly diagnosis that affects children in Kentucky at a higher incidence than those nationally. Limited exposures in children early in life to warrant the development and progression of brain cancer point to the role parental exposures experienced in the period prior to conception and throughout pregnancy may play in its development. Many of these exposures may be experienced through occupation. Data on a subset of pediatric brain cancer cases in Kentucky was compared to all cases diagnosed in the state from 1995 to 2019. Survey data of the study sample was collected …

Development And Validation Of A Questionnaire To Assess Awareness And Knowledge Of Nonalcoholic Fatty Liver Disease, A Liver Cancer Etiological Factor, Among Chinese Young Adults, Yi Du, Fedja A. Rochling, Dejun Su, Kendra Ratnapradipa, Jianghu James Dong, Evi A. Farazi

Journal Articles: Epidemiology

PURPOSE: Despite the increasing prevalence of nonalcoholic fatty liver disease (NAFLD), a liver cancer etiological factor, among Chinese young adults (CYA), there is a lack of valid, reliable, ready-to-use survey instruments for assessing awareness and knowledge of NAFLD in this population. The aims of this study were to develop, validate, and assess the reliability of a web-based, self-administered questionnaire evaluating awareness and knowledge of NAFLD among CYA.

METHODS: Based on review of relevant literature, a draft questionnaire was initially developed. Face and content validity of the questionnaire was evaluated by an expert panel of seven gastroenterologists. The construct validity was …

Massachusetts Prevalence Of Opioid Use Disorder Estimation Revisited: Comparing A Bayesian Approach To Standard Capture-Recapture Methods, Jianing Wang, Nathan Doogan, Katherine L. Thompson, Dana Bernson, Daniel Feaster, Jennifer Villani, Redonna Chandler, Laura F. White, David Kline, Joshua A. Barocas

Statistics Faculty Publications

Background: The National Survey on Drug Use and Health (NSDUH) estimated the prevalence of opioid use disorder (OUD) among the civilian, noninstitutionalized people aged 12 years or older in Massachusetts as 1.2% between 2015 and 2017. Accurate estimation of the prevalence of OUD is critical to the success of treatment and resource planning. Various indirect estimation approaches have been used but are subject to data availability and infrastructure-related issues.

Methods: We used 2015 data from the Massachusetts Public Health Data Warehouse (PHD) to compare the results of two approaches to estimating OUD prevalence in the Massachusetts population. First, we used …

Nonsystematic Reporting Biases Of The Sars-Cov-2 Variant Mu Could Impact Our Understanding Of The Epidemiological Dynamics Of Emerging Variants, Mary E. Petrone, Carolina Lucas, Bridget Menasche, Mallery I. Breban, Inci Yildirim, Melissa Campbell, Saad B. Omer, Edward C. Holmes, Albert I. Ko, Nathan D. Grubaugh, Akiko Iwasaki, Craig B. Wilen, Chantal B. F. Vogels, Joseph R. Fauver

Journal Articles: Epidemiology

Developing a timely and effective response to emerging SARS-CoV-2 variants of concern (VOCs) is of paramount public health importance. Global health surveillance does not rely on genomic data alone to identify concerning variants when they emerge. Instead, methods that utilize genomic data to estimate the epidemiological dynamics of emerging lineages have the potential to serve as an early warning system. However, these methods assume that genomic data are uniformly reported across circulating lineages. In this study, we analyze differences in reporting delays among SARS-CoV-2 VOCs as a plausible explanation for the timing of the global response to the former VOC …

Biomarkers Of Toxic Exposure And Oxidative Stress Among U.S. Adult Users Of Premium Cigar Versus Other Cigar Subtypes: 2013-2019, Hongying Dai, Neal L. Benowitz, Eleanor Rogan, Abraham Degarege, James Buckley, Ali S. Khan

Journal Articles: Epidemiology

INTRODUCTION: Cigars are currently the second-highest-used combustible tobacco product among U.S. adults, but knowledge about health effects of premium cigars versus other cigar subtype use is limited.

AIMS AND METHODS: This study analyzed the biospecimen data (n = 31 875) from Waves 1-5 of the Population Assessment of Tobacco and Health Study, collected during 2013-2019. Multivariable generalized estimation equations, accounting for within-person clustering, were conducted to examine differences in urine biomarkers of exposure (BOE) from five classes of harmful and potentially harmful constituents along with a biomarker of oxidative stress (urine 8-isoprostane) among exclusive users of premium cigars versus other …

Evaluation Of Theoretical Frameworks To Detect Correlates Of Hpv Vaccination In The Midwest, Us, Using Structural Equation Modeling, Abraham Degarege, Shinobu Watanabe-Galloway, Kristyne Mansilla, Rahel M. Sileshi, Edward S. Peters

Journal Articles: Epidemiology

Knowledge of a valid, well-designed, and targeted theory-based framework helps better characterize reasons for HPV vaccine hesitancy and identify promising approaches to increase vaccination rates for eligible individuals. This study evaluated health theories in explaining factors affecting HPV vaccination and used a theoretical framework to identify direct and indirect predictors and mediators of HPV vaccination. A cross-sectional survey regarding HPV vaccine uptake and related factors was conducted among 1306 teenagers and young adults in the Midwest, US, in March and April 2023. Structural equation modeling confirmed fit of the framework based on the Integrated Health Theory (IHT) to the HPV …

Barriers And Challenges For Visually Impaired Students In Pe - An Interview Study With Students In Austria, Germany, And The Usa, Sebastian Ruin, Justin A. Haegele, Martin Giese, Jana Baumgärtner

Human Movement Studies & Special Education Faculty Publications

Physical education (PE) is an important part of school education worldwide, and at the same time, almost the only subject that explicitly deals with body and movement. PE is therefore of elementary importance in the upbringing of young people. This also applies to children with visual impairments. However, existing findings on participation and belonging in PE as well as on physical and motor development reveal that this group of children and adolescents is noticeably disadvantaged in this respect. Against this background, this paper aims to explore fundamental barriers and challenges across different types of schools, types of schooling, and countries …

Prospective Investigation Of Insomnia Symptoms And Sleep Duration As Risk Factors For Stroke Incidence And All-Cause Mortality In U.S Adult, Wendemi Sawadogo

Theses and Dissertations

Background and Objectives: Stroke is the second leading cause of death in the world. In the United States, on average, someone has a stroke every 40 seconds and someone dies as a result of stroke every 3.5 minutes. Identifying modifiable risk factors of stroke is therefore a public health priority. The purpose of this study was to investigate the extent to which insomnia symptoms and sleep duration contribute to stroke incidence, all-cause mortality, and explore potential causal pathways.

Methods: The Health and Retirement Study (HRS) and the REasons for Geographic And Racial Differences in Stroke (REGARDS) study were …

An Epidemiological Synthesis Of Emerging And Re-Emerging Zoonotic Disease Threats In Cameroon, 2000-2022: A Systematic Review, Nancy B. Tahmo, Frankline Sevidzem Wirsiy, Dum-Buo Nnamdi, Marcel Tongo, James V. Lawler, M. Jana Broadhurst, Charles S. Wondji, David Brett-Major

Journal Articles: Epidemiology

INTRODUCTION: Population factors such as urbanization, socio-economic, and environmental factors are driving forces for emerging/re-emerging zoonotic diseases in Cameroon. To inform preparedness and prioritization efforts, this study mapped out epidemiological data (including prevalence) of zoonotic diseases occurring in Cameroon between 2000 and 2022 by demographic factors.

METHODS: Following the PRISMA guidelines, a protocol was registered in the PROSPERO database (CRD42022333059). Independent reviewers searched the PubMed, Embase, CINAHL, Cochrane, and Scopus databases on May 30, 2022 for relevant articles; duplicates were removed, and the titles, abstracts, and full texts were screened to identify eligible articles.

RESULTS: Out of 4142 articles identified, …

The Association Between Mediated Deprivation And Ovarian Cancer Survival Among African American Women, Andrew B. Lawson, Joanne Kim, Courtney Johnson, Kendra Ratnapradipa, Anthony J. Alberg, Maxwell Akonde, Theresa Hastert, Elisa V. Bandera, Paul Terry, Hannah Mandle, Michele L. Cote, Melissa Bondy, Jeffrey Marks, Lauren C. Peres, Joellen Schildkraut, Edward S. Peters

Journal Articles: Epidemiology

BACKGROUND: Deprivation indices are often used to adjust for socio-economic disparities in health studies. Their role has been partially evaluated for certain population-level cancer outcomes, but examination of their role in ovarian cancer is limited. In this study, we evaluated a range of well-recognized deprivation indices in relation to cancer survival in a cohort of self-identified Black women diagnosed with ovarian cancer. This study aimed to determine if clinical or diagnostic characteristics lie on a mediating pathway between socioeconomic status (SES) and deprivation and ovarian cancer survival in a minority population that experiences worse survival from ovarian cancer.

METHODS: We …

Dynamic Patterns And Modelling Of Covid-19 Early Transmission By Dynamic Mode Decomposition, Dehong Fang, Lei Guo, M. Courtney Hughes, Jifu Tan

Faculty Articles, Papers, and Other Scholarship

Introduction

Understanding the transmission patterns and dynamics of COVID-19 is critical to effective monitoring, intervention, and control for future pandemics. The aim of this study was to investigate the spatial and temporal characteristics of COVID-19 transmission during the early stage of the outbreak in the US, with the goal of informing future responses to similar outbreaks.

Methods

We used dynamic mode decomposition (DMD) and national data on COVID-19 cases (April 6, 2020–October 9, 2020) to model the spread of COVID-19 in the US as a dynamic system. DMD can decompose the complex evolution of disease cases into linear combinations of …

Sleep Aid Use During Early Pregnancy And The Risk Of Birth Defects, Meredith M. Howley

Legacy Theses & Dissertations (2009 - 2024)

This dissertation examines the validity of maternal self-reported medication exposures and then explores the associations between self-reported sleep aid use, including zolpidem specifically, and birth defects using data from three population-based case-control studies conducted within the United States. The first aim of this dissertation was to explore agreement between two sources of prescription medication use in early pregnancy: medical records and self-reported interview data from the Birth Defects Study To Evaluate Pregnancy exposureS (BD-STEPS). We observed that agreement of prescription data between self-report and medical records varies by whether the medication is used chronically or episodically. While self-reported medication information …

Maternal Exposure Of Perfluoroalkyl Substances (Pfas) During Pregnancy And Wheeze In Children : The Upstate Kids Study, Faria Sharmin

Legacy Theses & Dissertations (2009 - 2024)

Background: Prenatal exposure to perfluoroalkyl substances (PFASs), a group of persistent environmental chemicals with endocrine disrupting abilities, has been associated with immunomodulation and may contribute to the etiology of asthma in young children. The need for research and additional prospective analysis clearly exists to measure the impact of the chemicals (PFAS) on child wheeze or asthma. We used newborn dried blood spots to quantify two PFAS and their associations with infant wheeze in the Upstate KIDS population.Methods: We measured, perfluoro octane - sulfonic acid (PFOS) and perfluorooctanoic acid (PFOA) in 2071 singleton and 1040 twin infants born to mothers in …

Association Of Prenatal Exposure To Air Pollutants With Select Birth Defects Using The Case-Cohort Approach, Abigail Jeanne Stamm

Legacy Theses & Dissertations (2009 - 2024)

Background: Annually, 3-5% of infants are born with birth defects in the United States. In New York State (NYS), air pollution, specifically ozone (O3) and fine particulate matter (PM2.5), is detectable at levels that affect human health. Air pollution is associated with poor birth outcomes and contains components that are suspected to cause oxidative stress, which is one mechanism by which birth defects are formed.Methods: This study investigated the relationship between the development of select birth defects (oral clefts, craniosynostosis, and clubfoot) in singleton live births in NYS between 2002 and 2015 and weekly peak and average concentrations of O3 …

Trajectories Of Maternal Parenting Stress And Adolescent Behavioral Symptoms In Unmarried Families : The Roles Of Family Immigration Status, Harsh Parenting, And Father’S Early Involvement, Fei Tang

Legacy Theses & Dissertations (2009 - 2024)

BackgroundAdolescence is a critical period for developing social and emotional wellbeing. Adolescents experience many physical and social changes, making them vulnerable to adaptive and behavioral problems. Compared to their peers in married families, adolescents in unmarried families may be at particularly elevated risk of developing internalizing and externalizing behavioral problems, identifying key risk factors in a family context could provide insights on the development of family-based interventions. Mothers are often seen as the center of the environmental context of children development, their responsiveness to children may be impacted by their economic and psychological resources, which could crucially affect the wellbeing …

Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Step Towards Unfolding The Mystery, Aditi Kamlesh Bhanushali

Legacy Theses & Dissertations (2009 - 2024)

AbstractBackground: Myalgic Encephalomyelitis, also known as chronic fatigue syndrome (CFS), is a complex disease that includes the dysregulation of the Central Nervous system. There is no exact known etiology or pathophysiology which leads to the development of ME/CFS. To understand the possible causes behind this mysterious disease, I conducted this project under the guidance of Dr. Moslehi to evaluate a range of demographic, lifestyle, and epidemiological factors and their risk in the development of ME/CFS. Methods: My project is part of a case-control study conducted by Dr. Roxana Moslehi. ME/CFS is a rare disease, so a case-control study design was …

Evaluating Spatial Relationships Between Environmental Factors And Contextual Sociodemographic Burden And Associations With Respiratory Morbidity Among Young Children: An Indicator-Based Approach, Neil Anthony Muscatiello

Legacy Theses & Dissertations (2009 - 2024)

The body of public health literature related to air pollution epidemiology is extensive. Similarly, the body of literature related to social epidemiology has also expanded greatly in recent years. While studies in these sub-disciplines of epidemiology sometimes seek to control for variables more commonly studied in one or the other, fewer studies report on their combined effects. Studies which do attempt to summarize how the combined air pollution burden and contextual sociodemographic burden differentially effect health outcomes beyond their individual effects could be beneficial in understanding links between the environment and certain health outcomes such as childhood asthma. The proposed …

Gestational Epigenetic Aging : Prenatal Influences And Early Life Associations, Emilia Pawlowski

Legacy Theses & Dissertations (2009 - 2024)

Development Origins of Health (DOHaD) evidence suggests that prenatal exposures have an important impact on offspring health throughout the life course. Environmental and psychosocial exposures during fetal development are associated with a range of health outcomes for offspring, and effects are often sex specific. One of the mechanisms which may explain differences in health outcomes is epigenetic alterations, which are the molecular mechanisms that regulate gene expression and can be modified during fetal development. Many studies have shown that psychosocial stress and social adversity can modulate epigenetic mechanisms and affect health. While there are several methods for measuring epigenetic alterations, …

Examining The Association Between Childhood Adversity And Later Life Cardiometabolic Diseases, Shreya Shrinivas

Legacy Theses & Dissertations (2009 - 2024)

ACEs stands for Adverse Childhood Experiences, which are traumatic or stressful events that occur in childhood before the age of 18 (Wisner, 2022). These experiences can include physical, emotional, or sexual abuse; neglect; household dysfunction, such as parental separation, domestic violence, substance abuse, or incarceration; or exposure to community violence, racism, or discrimination. Research has shown that individuals who experience ACEs are at a higher risk for developing chronic diseases such as heart disease, diabetes, cancer, and mental health disorders later in life (Felitti, 2002). This is because ACEs can cause toxic stress, which is chronic activation of the stress …

Public Health Interventions Guided By Houston’S Wastewater Surveillance Program During The Covid-19 Pandemic, Loren Hopkins, Katherine B Ensor, Lauren Stadler, Catherine D Johnson, Rebecca Schneider, Kaavya Domakonda, James J Mccarthy, Edward J Septimus, David Persse, Stephen L Williams

Faculty, Staff and Student Publications

Since the start of the COVID-19 pandemic, wastewater surveillance has emerged as a powerful tool used by public health authorities to track SARS-CoV-2 infections in communities. In May 2020, the Houston Health Department began working with a coalition of municipal and academic partners to develop a wastewater monitoring and reporting system for the city of Houston, Texas. Data collected from the system are integrated with other COVID-19 surveillance data and communicated through different channels to local authorities and the general public. This information is used to shape policies and inform actions to mitigate and prevent the spread of COVID-19 at …

Identification Of Novel Biosynthetic Gene Clusters Encoding For Polyketide/Nrps-Producing Chemotherapeutic Compounds From Marine-Derived Streptomyces Hygroscopicus From A Marine Sanctuary, Hannah Ruth Flaherty

Honors Theses and Capstones

Nearly one out of six deaths in 2020, around ten million people, were caused by cancer, making it a leading cause of death worldwide (WHO, 2022). This major public health issue, in addition to the rise of multidrug-resistant (MDR) pathogens, provides a high demand for the discovery of new pharmaceutical drugs to be used clinically to treat these conditions. The Streptomyces genus accounts to produce 39% of all microbial metabolites currently approved for human health, indicating its potential as an important species to study for antimicrobial and anticancer agents. The long linear genome of Streptomyces contains specialized sequences known as …

The Daily Patterns Of Emergency Medical Events, Mary Elizabeth Helander, Margaret K. Formica, Dessa K. Bergen-Cico

Social Science - All Scholarship

This study examines population level daily patterns of time-stamped emergency medical service (EMS) dispatches to establish their situational predictability. Using visualization, sinusoidal regression, and statistical tests to compare empirical cumulative distributions, we analyzed 311,848,450 emergency medical call records from the U.S. National Emergency Medical Services Information System (NEMSIS) for years 2010 through 2022. The analysis revealed a robust daily pattern in the hourly distribution of distress calls across 33 major categories of medical emergency dispatch types. Sinusoidal regression coefficients for all types were statistically significant, mostly at the p < 0.0001 level. The coefficient of determination ($R^2$) ranged from 0.84 and 0.99 for all models, with most falling in the 0.94 to 0.99 range. The common sinusoidal pattern, peaking in mid-afternoon, demonstrates that all major categories of medical emergency dispatch types appear to be influenced by an underlying daily rhythm that is aligned with daylight hours and common sleep/wake cycles. A comparison of results with previous landmark studies revealed new and contrasting EMS patterns for several long-established peak occurrence hours--specifically for chest pain, heart problems, stroke, convulsions and seizures, and sudden cardiac arrest/death. Upon closer examination, we also found that heart attacks, diagnosed by paramedics in the field via 12-lead cardiac monitoring, followed the identified common daily pattern of a mid-afternoon peak, departing from prior generally accepted morning tendencies. Extended analysis revealed that the normative pattern prevailed across the NEMSIS data when re-organized to consider monthly, seasonal, daylight-savings vs civil time, and pre-/post- COVID-19 periods. The predictable daily EMS patterns provide impetus for more research that links daily variation with causal risk and protective factors. Our methods are straightforward and presented with detail to provide accessible and replicable implementation for researchers and practitioners.

Marineepi: A Gui-Based Matlab Toolbox To Simulate Marine Pathogen Transmission, Gorka Bidegain, Tal Ben-Horin, Eric N. Powell, John M. Klinck, Eileen E. Hofmann

CCPO Publications

The Graphical User Interface (GUI) MarineEpi is presented as a Matlab toolbox for easily (i) constructing disease transmission models for different marine host-pathogen systems, (ii) running simulations by specifying initial conditions and model parameters, and (iii) interpreting the resulting time series of the host and pathogen population dynamics. MarineEpi users can generate models for systems in which pathogen transmission occurs through contact with infected individuals (SI), contact with dead infected individuals (SID), contact with environmental pathogens released by infected individuals (SIP), and contact with environmental pathogens released by dead infected individuals (SIPD). MarineEpi is a freely available GUI that provides …

Changes In Severity Of Diabetes At Diagnosis Following The Onset Of The Sars-Cov-2 Pandemic, Annelise King

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

During the SARS-CoV-2 pandemic it was seen that diabetes was a risk factor for severe COVID-19. The objective of this study is to assess the severity of diabetes at diagnosis during the COVID-19 pandemic compared to pre-pandemic to see how the pandemic and SARS-CoV-2 infection impacted the severity of diabetes. This study used University of Kentucky electronic health records of 13,794 patients who developed diabetes. The majority of patients were female, white non-Hispanic, 65+, and living in an urban area. There were differences seen between the COVID-19 positive and negative cohorts in the DKA and HbA₁c variables, with …

Community Pharmacy Provision Of Extended-Release Injectable Naltrexone In Kentucky: Perspective Of People Who Use Opioids, Anye Wamucho

Theses and Dissertations--Public Health (M.P.H. & Dr.P.H.)

Aim: To identify demographic, socio-economic, and other factors associated with likelihood of obtaining extended-release injectable naltrexone (EIN) if provided in a private space at a local pharmacy among people who use opioids (PWUO) in rural Appalachian Kentucky.

Methods: People who used opioids in the past 6 months in rural Appalachian Kentucky (n=170) completed interviewer-administered questionnaires eliciting demographic, socio-economic, and other characteristics. Participants were also asked about whether they will be more likely to obtain EIN if provided in a private space at a local pharmacy. Factors associated with increased likelihood to obtain pharmacy-provided EIN were assessed using unadjusted univariate and …

A Systematic Review To Study The Global Patterns And Policies Of Hiv Harm Reduction Programs And Their Impact Among People Who Inject Drugs, Noura Shaltout, Rania Soliman, Lamia Refaey, Rim Ghazal, Mirna Atteya, Nahla Elmedany

Papers, Posters, and Presentations

Aim: This study aims to provide an updated estimate of HIV prevalence among people who inject drugs (PWID) globally, as well as investigate different policies and methods for applying harm reduction. This article focuses on the two major and the most frequently used harm reduction techniques, Syringe-Service Programs (SSPs) and Opioid Agonist Therapy (OAT). Methods: A comprehensive systematic review was undertaken across multiple international databases during the period of (August-December 2021). For studies conducted before 2005, we used data from a previous published systematic review. Thirty-six studies were included, including studies that had performed HIV testing and had a confirmed …

Striving For Appropriate Antibiotic Use: A Biomarker Initiative, And Outcomes Associated With Azithromycin Exposure, Amanda Gusovsky

Theses and Dissertations--Pharmacy

The introduction of antibiotics into clinical practice is considered the greatest medical breakthrough of the 20^thcentury. However, the use of antibiotics can contribute to the development of resistance. In the United States (U.S.), approximately 2.8 million people are infected with antibiotic-resistant bacteria each year, and more than 35,000 people die as a result. Moreover, some antibiotics are known to cause cardiac side effects including QT prolongation, hypotension, and ventricular arrythmias. The U.S. Centers for Disease Control and Prevention (CDC) defines appropriate antibiotic use as the effort to use “the right antibiotic, at the right dose, for the right …

Genetic And Pharmacogenetics Associations Of Cancer Disparities In Appalachia, Nan Lin

Theses and Dissertations--Pharmacy

Individuals residing in Appalachian regions have significant health disparities, including higher cancer incidence and mortality rates. Previous studies have addressed the impact of socioeconomic status and environmental risk factors on Appalachia cancer disparities, while few studies have evaluated genetic risk factors.

Germline whole exome sequencing samples from 7,078 individuals with cancer (759 Appalachians) were evaluated. Demographics and relatedness were assessed using KING. Ethnicity was verified by principal component analysis using TRACE, which included 6,034 individuals (85%) of European genetic ancestry. After QC filtering, 5,980 individuals were analyzed. To assess the overall predisposition of hereditary disease, gene level frequency of likely …

Studies Of Polypharmacy And Medication Therapy Management In Population-Based Cohorts, Ximena A. Oyarzun Gonzalez

Theses and Dissertations--Epidemiology and Biostatistics

According to the United States Census Bureau, 16.8% of the population was 65 years and older in 2021, and it is expected that by 2060 that number will increase to about 30% (about 114 million people). Aging is associated with physiological changes in all systems of the body. These changes impact the pharmacodynamics and pharmacokinetic characteristics of drugs. Furthermore, older adults usually have several chronic conditions, which increases their exposure to medications. Increased vulnerability combined with increasing exposure puts elderly people at higher risk for drug interactions and adverse events.

Charlesworth et al. (2014) found that the prevalence of polypharmacy, …

Evaluating The Impact Of Mental Health Needs And Services Disruption: Covid-19 & Wisconsin Children’S Welfare Services, Gavin Rienne

Theses and Dissertations--Epidemiology and Biostatistics

Children’s traumatic experiences have lifelong impacts on their mental health and quality of life, therefore mental health services are a critical part of necessary community resources. The increased frequency and severity of natural disasters such as hurricanes, tornadoes, and pandemics reinforces the need to examine and understand the importance of mental health and child services in response to disaster events. This research assesses the relationship between disasters and subsequent health service utilization amongst children and adolescents. We investigated current research on the relationship between children’s mental health and community mental health resource efficacy and accessibility after a major disaster by …