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 …

Prenatal Exposure To Nicotine And Postpartum Depression: A Systematic Review And Meta-Analysis, Reem Sharaf-Alddin, May Salama, Denise Mckinney, George Saade, Qi Zhang

Health Behavior, Policy & Management Faculty Publications

Purpose: Postpartum Depression (PPD) is the most common mental health complication of childbirth, and has short-term and long-term consequences for mother, child, and the entire family. PPD is a function of several factors. Prenatal exposure to nicotine (PEN) by Active Tobacco Smoking (ATS), Secondhand Smoking (SHS), or Electronic Nicotine Products (ENPs) is a major potential risk factor. This systematic review and meta-analysis aim to summarize and evaluate all evidence regarding the association between PEN and PPD.

Methods: We searched the following databases, PubMed, Medline, Cochrane, EMBASE, and CINHAL, for studies published between Jan.1st ,2000&Sep.19th ,2024, with the outcome PPD. Studies …

Rurality, Infant Feeding Practices, And Perinatal Cardiovascular Health Behaviors, Elly Marie Marshall

Graduate Theses, Dissertations, and Problem Reports (ETD)

Introduction: Cardiovascular diseases are a leading cause of pregnancy-related deaths in the United States, with higher rates in rural areas. While limited healthcare access contributes to this disparity, other factors remain unclear. Breastfeeding provides long-term protection against cardiovascular disease, but modern infant feeding practices are complex and may impact maternal cardiovascular health (CVH) in unexpected ways. Healthy CVH behaviors of sufficient sleep duration, adequate physical activity, a healthy diet, and nicotine avoidance can enhance protection against future cardiovascular disease risk. Therefore, the aims of this dissertation are to 1) assess associations between rurality and first trimester CVH behaviors; 2) synthesize …

Spatial Analyses Using Emergency Medical Services Data To Inform Healthcare., Jeffrey Alan Pesarsick

Graduate Theses, Dissertations, and Problem Reports (ETD)

Spatial analyses using Emergency Medical Services data to inform healthcare.

Jeffrey Pesarsick

Background

Emergency Medical Services (EMS) often serve as the initial entry point for patients into the healthcare system in the United States.  Rural health disparities, geographic isolation, socioeconomic disadvantages, and operational challenges create disparities in access to EMS services.  Disparities include prolonged response times, less resources available, and inequities in levels of care available.  The overall goal of these series of projects was to quantify the extent to which operational challenges in EMS data impact health, and how EMS data could be used to identify neighborhood level trends …

Under-Five Mortality Estimation Methods: A Methodological Systematic Review, Bereket Kefale, Jonine Jancey, Amanuel T. Gebremedhin, Daniel Gashaneh Belay, Gavin Pereira, Gizachew A. Tessema

Research outputs 2022 to 2026

Purpose This methodological systematic review aimed to identify and synthesise the existing under-five mortality (U5M) estimation methods globally. Methods We searched seven databases including Medline, Embase, Scopus, Web of Science, CINAHL, Global Health, and ProQuest Central, as well as grey literature sources from inception to September 25, 2025. The review protocol was prospectively registered in the International Prospective Register of Systematic Reviews (PROSPERO) (CRD42023465476). Results Fifty-six studies were included in this review. The most frequently employed child mortality estimation method was the indirect method (n = 16), followed by the Global Burden of Disease (GBD) study method (n = 12) …

Chronic Disease Prevalence And Modifiable Risk Factors Among Undergraduate Students At Ha’Il University: A Population-Level Cross-Sectional Study, Collins Otieno Asweto, Sehar Un Nisa Hassan, Mohamed Ali Alzain, Bandar Alsaif, Mohammed Elshiekh Saeed, Ahmed Kassar, Kamal Elbssir Mohammed Ali, Mouna Ghorbel, Rafat Zrieq, Monzer Hamed, Wei Wang

Research outputs 2022 to 2026

Background: Rising rates of chronic conditions among Saudi youth underscore the need for early prevention. Using a public‑health lens focused on demographic, academic, and lifestyle influences, this study investigates the risk and protective factors for chronic disease among students at the University of Ha’il to guide youth‑centered health policies and long‑term wellbeing initiatives. Methods: A cross-sectional survey was conducted among 10,775 undergraduate students studying in bachelor’s degree programs at Ha’il University, Saudi Arabia. Descriptive analyses were used to assess demographic characteristics, academic status, health status, and health-related lifestyles. Multiple logistic regression models were applied to determine which demographic, academic, and …

Understanding The Syphilis Resurgence Among Females Of Childbearing Age: Informing Prevention Efforts In New York State, Salvatore Currenti

Electronic Theses & Dissertations (2024 - present)

Syphilis is caused by Treponema pallidum and transmitted through direct contact with infected mucosal lesions and via vertical transmission during pregnancy (i.e., congenital). Transmission of syphilis to an infant during pregnancy (i.e., congenital syphilis [CS]) can lead to early fetal death, stillbirth, neonatal death, preterm birth, low birthweight, and congenital infection in infants. The United States (U.S.) is experiencing epidemic increases in both females of reproductive age with syphilis and infants with CS. In New York State (NYS), these trends have also occurred, especially after COVID-19 emergence, and increases in reported cases and incidence rates are comparable to national statistics. …

Associations Between Neighborhood Physical And Social Stressors During Sensitive Developmental Periods And Substance Use In Early Adulthood, Abigail M. Ulofoshio

Electronic Theses & Dissertations (2024 - present)

Background

Substance use is a major public health problem. Neighborhood disadvantage and related stressors have been linked to increased substance use in adolescence and early adulthood, although findings are mixed. No studies have explored whether the timing or accumulation of neighborhood stressors in childhood and adolescence impact substance use in early adulthood. This study aims to investigate to what extent physical and social neighborhood stress during sensitive developmental periods influence substance use dependency and illicit substance use in early adulthood.

Methods

We analyzed an imputed sample (n = 7,494) from the Avon Longitudinal Study of Parents and Children (ALSPAC), a …

Hepatitis C Among Persons Who Inject Drugs In New York State: Progress Towards Elimination, Meredith A. Barranco

Electronic Theses & Dissertations (2024 - present)

Background: Hepatitis C virus (HCV) infection is one of the leading causes of liver disease in the United States (US) and worldwide. In the United States today, HCV is transmitted primarily through injection drug use (IDU) and therefore disproportionately impacts persons who inject drugs (PWID), a population with a range of complex social and health needs. HCV is not vaccine-preventable but can be cured in over 90% of cases with an 8–12-week course of daily direct-acting antiviral (DAA) medication. Since approval of curative medications in 2014, various jurisdictions have developed plans to eliminate HCV. In 2021, the New York State …

Health Insurance As A Mediator Of Neighborhood Deprivation And Pediatric Cancer Survival: An Analysis Of State Cancer Registry Data, Emma Hymel, Cheng Zheng, Jenna Allison, Kendra L. Ratnapradipa, Edward S. Peters, Sarah H. Nash, Mei-Chin Hsieh, Shinobu Watanabe-Galloway

Journal Articles: Epidemiology

INTRODUCTION: To develop interventions to reduce neighborhood-level disparities in pediatric cancer outcomes, it is necessary to understand their underlying mechanisms. It has been suggested that individual-level health insurance is a mediator of neighborhood deprivation and pediatric cancer survival.

METHODS: This study was a population-based longitudinal study of children with cancer from 2000 to 2020 in the Iowa Cancer Registry and Louisiana Tumor Registry. Neighborhood deprivation was measured using the Area Deprivation Index. Log-binomial regression models were used to identify predictors of health insurance status at diagnosis. Cox regression models were used to assess the association between health insurance status at …

Outbreak Preparedness And Response In A Globalized World: Are We Ready?, Francesca F. Norman, David Brett-Major, Chiara Sepulcri, Emmanuel Bottieau, Theresa Sepulveda, Federica Toscanini, Laura A. Nicolini, Jesse J. Waggoner, Sami Alcedo, Davidson H. Hamer, Ralph Huits, Michael Libman, Geosentinel Network, Tropnet Network, Kevin O'Laughlin

Journal Articles: Epidemiology

BACKGROUND: Recent global epidemics and pandemics have highlighted the need for adequate diagnostic capacities to respond to emerging threats. Strengthening operational capacities can lead to improved preparation; investing in emergency response infrastructure may diminish progression of outbreaks and prevent escalation.

METHODS: An email-linked survey was sent January-March-2025 to two global infectious disease surveillance networks' (GeoSentinel and TropNet) participating clinics assessing capacity for Oropouche virus (OROV) diagnostic testing. Data on testing capacity for other arboviruses was also requested.

RESULTS: Responses were obtained for 58 GeoSentinel/TropNet sites (58/104, 55.8%): 50% responding sites (29/58) had OROV diagnostic testing available at a public reference …

Climate And Other Environmental Factors Predict Tick Abundance And Lyme Cases In Minnesota One And Two Years In Advance, Kathleen E. Angell, Janet Jarnefeld, Elizabeth K. Schiffman, M. Jana Broadhurst, Jianghu James Dong, Abraham Degarege, Roberto Cortinas, David Brett-Major

Journal Articles: Epidemiology

BACKGROUND: Environmental factors, like weather and host abundance influence tick populations which in turn affect tickborne disease in endemic regions. It is important to understand how these factors are associated with tick abundance, and whether they can predict disease. We assessed associations between environmental factors, tick abundance, and human Lyme disease cases in the same year and with one- and two-year lags in Minnesota. In parallel, we compare conventional analytical methods with a novel machine learning approach to evaluate their relative strengths and potential for integration.

METHODS: Environmental and tick abundance relationships were examined using generalized linear mixed-effects models (GLMM), …

When Clades Collide: Genomic Admixture In Blacklegged Ticks (Ixodes Scapularis) From The Great Plains, Kaylee S. Herzog, Zach Pella, Halie Smith, Dayna Mccormick, Lily Nuss, Amanda Brinkworth, Sujata S. Chaudhari, Kathryn Duncan, Kellee Sundstrom, Sydney Stein, Holly Black, Jose E. Pietri, Ryan C. Smith, Jeff Hamik, Roberto Cortiñas, Joseph R. Fauver

Journal Articles: Epidemiology

Ixodes scapularis ticks transmit a number of pathogens important to human health, including Borrelia burgdorferi sensu stricto, the causative agent of Lyme disease. While I. scapularis is found across the Eastern United States, Lyme disease transmission is largely limited to the Northeast and Upper Midwest and is nearly absent in the South. This indicates that differences in northern versus southern clades of I. scapularis are associated with differences in Lyme disease transmission risk. Ixodes scapularis is undergoing range expansion, including into the Great Plains region of the United States. Determining where I. scapularis populations in the Great Plains originated can …

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, …

Combined Effects Of Cumulative Triglyceride-Glucose And Blood Pressure On Stroke In Middle-Aged And Older Chinese Adults: A Longitudinal Analysis, Xinyue Wang, Wen Zheng, Xiangqian Jin, Hongzhi Liu, Jiheng Hao, Liyong Zhang, Yuanyuan Gu, Haifeng Hou, Wei Wang

Research outputs 2022 to 2026

Background: The triglyceride-glucose (TyG) index has increasingly been recognised an indicator for stroke risk. We aimed to explore the relationship between TyG and blood pressure (BP) and the combined effects of cumulative TyG (CumTyG) and cumulative BP (CumBP) on stroke risk in a cohort of Chinese middle-aged and older adults. Methods: We enrolled 5138 participants from the 2011–2018 waves of the China Health and Retirement Longitudinal Study. Cumulative TyG and BP exposures were recorded between 2011 and 2015, and stroke incidence was then followed up until 2018. We conducted a cross-lagged panel analysis to address the temporal and directional relationships …

On Burden Of Diseases, Prevention, Medical Research And Health Service Delivery: Grampian Case Study, Seshadri S. Vasan, Sudarshan Anand, Miae Lee, Nicholas C. Fluck

Research outputs 2022 to 2026

Burden of diseases measured as disability-adjusted life years (DALYs) per 100,000 people can be mined from public domain data, when they are made available by population health surveillance systems. This can be analysed to allow insightful comparisons with the national average, and to understand differences in trends between the sexes, age groups, time periods, geographic regions, and sub-regions. In this illustrative case study, we have analysed the Scottish burden of disease database to understand what ailed the population of the Grampian region before the COVID-19 pandemic. We have identified that selected cancers, ischaemic heart disease, Alzheimer’s disease and other dementias …

Global, Regional, And National Burden Of Epilepsy, 1990–2021: A Global Burden Of Disease Study, Jinqing Zhao, Qiannan Chen, Jiahan Dong, Meng Gao, Siqi Ge, Anxin Wang

Research outputs 2022 to 2026

Background: Epilepsy is a common neurological disorder characterised by spontaneous seizures without an identifiable cause, leading to high morbidity and a significant public health burden. Understanding trends in its incidence, prevalence, mortality, and disability-adjusted life years (DALYs) is essential for developing effective prevention and treatment strategies. We aim to describe global trends in epilepsy over the past 32 years and explore the impact of sociodemographic index (SDI) levels on disease burden using the Global Burden of Disease 2021 data. Methods: We analysed the global burden of epilepsy (1990–2019) using age-standardised rates (ASRs) and their 95% uncertainty intervals (UI). We assessed …

Associations Between Modifiable Lifestyle Risk Factors And Abdominal Aortic Calcification In The Uk Biobank Imaging Study, Nicola P. Bondonno, Abadi K. Gebre, Benjamin H. Parmenter, Jonathan Hodgson, Lauren C. Blekkenhorst, Catherine P. Bondonno, Richard Woodman, John P. Kemp, James Webster, Carl Schultz, Cassandra Smith, Afsah Saleem, Syed Zulqarnain Gilani, Emma L. Duncan, Joseph Hung, Wai H. Lim, Parminder Raina, John T. Schousboe, Nicholas C. Harvey, Marc Sim, Joshua R. Lewis

Research outputs 2022 to 2026

Background and aims: Abdominal aortic calcification (AAC) reflects subclinical atherosclerotic cardiovascular disease (ASCVD), but its lifestyle determinants remain uncertain. We investigated how a Healthy Lifestyle Score (HLS) relates to AAC and whether AAC mediates the HLS-ASCVD association. Methods and results: Participants from the UK Biobank Imaging study were assessed for AAC from DXA images. A Healthy Lifestyle Score (HLS), based on smoking, physical activity, diet quality, alcohol consumption, sleep, and BMI was developed, and categorised as low, moderate and high. Cross-sectional associations with (i) any AAC (AAC≥1) and (ii) high AAC (AAC≥6) were analysed using multivariable-adjusted logistic regression models. The …

Multi-Omics Integration Reveals Vaccine-Specific Molecular Signatures And Temporal Dynamics Of Covid-19 Immune Responses, Anne H. Klein, David J. Beale, Thao V. Nquyen, Jian-Wei Liu, Petrus Jansen Van Vuren, Nagendrakumar B. Singanallur, Carol Lee, Andrew C. Boomer, Jennifer A. Juno, Stephen J. Kent, Adam K. Wheatley, Gough G. Au, Seshadri S. Vasan, Laurence Wilson, Alexander J. Mcauley

Research outputs 2022 to 2026

Vaccination elicits systemic immune responses that extend beyond antibody and lymphocyte activation, engaging coordinated metabolic and lipid pathways that modulate immune function. Nevertheless, how systemic molecular responses differ across COVID-19 vaccine platforms, including closely related mRNA platforms, remains poorly understood. Here, we performed integrated plasma proteomic, lipidomic, and metabolomic profiling of 53 SARS-CoV-2–naïve adults vaccinated with Pfizer-BioNTech, Moderna, or AstraZeneca COVID-19 vaccines. Samples were analysed across multiple timepoints using differential analysis and DIABLO-based multi-omics integration. Our findings reveal distinct platform-associated multi-omic molecular signatures not captured by unsupervised analyses alone. Pfizer-BioNTech vaccination was associated with widespread increases in immunoglobulin and complement …

Implementation Of Risk Prediction And Stratification Approaches For Ageing Populations In Australian Healthcare: A Systematic Review, Leanne Greene, Jacob Brain, Belinda Brown, Claire V. Burley, Elissa Burton, Zhongyang Guan, Bronwyn Myers, Katherine Ride, Serena Sabatini, Mario Siervo, Abay Woday Tadesse, Eugene Yee Hing Tang, Blossom C.L. Stephan, Jennifer Dunne

Research outputs 2022 to 2026

Despite widespread development of prognostic risk stratification tools, their implementation in Australian healthcare remains poorly characterised. This review identified tools implemented for adults aged ≥40 years and examined their real-world use. Following PRISMA and SWiM guidelines, MEDLINE, EMBASE, Web of Science, PsycINFO, and CINAHL Plus were searched from inception to 20th February 2026. Eligible studies reported implementation of a risk stratification tool in Australian healthcare and health, functional, or implementation outcomes. The Mixed Methods Appraisal Tool assessed study quality. Of 7115 records screened, 21 studies were included across primary care, hospitals, residential aged care, and community services. Interventions included electronic …

Cannabinoid Impacts On Ethnic Modulation Of Atrial Septal Defect Prevalence Usa, Albert Stuart Reece, Gary Kenneth Hulse

Research outputs 2022 to 2026

Objective: To conduct a detailed epidemiological exploration of the relative contributions of cannabis and ethnicity to US atrial septal defect (ASD) rates (ASDR). Study design: State-based ASDR data from the US National Births Defects Prevention Network, substance use, income and ethnicity data analyzed in RStudio. Results: Ethnic effects were significant with relative risks amongst African Americans and American Indians and Alaskan Natives of 2·40 (95%C.I. 2·27, 2·54) and 2·31 (2·19, 21·43), Cohen’s D of 1·44 and 1·46 and P values of 2·94 × 10⁻¹⁶⁸ and 3·01 × 10⁻¹⁷² compared to others, respectively. In general, additive models inclusion of …

Machine Learning Prediction Of Incident Hypertension In Australian Men: Integrating Survey, Pharmaceutical And Healthcare Utilisation Data From The Ten To Men Cohort, Ebenezer Afrifa-Yamoah, Emmanuel Peprah-Yamoah, Victor Opoku-Yamoah, Eric Adua

Research outputs 2022 to 2026

Background: Hypertension is a leading modifiable contributor to cardiovascular disease. We developed and evaluated machine learning models to predict incident hypertension in Australian men using baseline survey data linked to pharmaceutical (PBS) and healthcare utilisation (MBS) administrative records from the Ten to Men cohort.

Methods: Among 13,519 men free of hypertension at baseline (2014), incident hypertension over 10 years was ascertained from PBS antihypertensive dispensing. Twenty-five baseline features spanning sociodemographic, anthropometric, lifestyle, clinical and administrative domains were used to train logistic regression, random forest, gradient boosting and XGBoost models, evaluated by five-fold cross-validation with out-of-fold prediction. Discrimination, calibration and threshold-based …

Air Quality Risks In Public Housing, Brynn Sheehan, Carolyn Caraballo Velez, Vaughan W. Rees, Miasha T. O'Neal, Kristen E. Moore, Katie M. Jones, Jessica Meadows, Sarah Gehlert, Richard Grucza, Andrew Plunk, Kelli J. England

Department Psychiatry & Behavioral Science Faculty Publications

Importance Public housing residents face elevated environmental health risks, yet indoor air quality in these settings remains underexamined. OBJECTIVE: To evaluate indoor air quality in public housing 5 years after implementation of the federal smoke-free housing policy and compare it with outdoor air quality in the same regions.

Design, Setting, and Participants A 1-year cohort study of indoor air quality (particulate matter ≤2.5 μm in diameter [PM2.5]) across 12 multifamily public housing communities in southeastern Virgina for individuals 65 years and older or persons with disability in cities with the highest rated outdoor air quality. Indoor PM2.5 was continuously measured …

Differential Impact Of Admission Type And Clinical Complexity On Diabetes Hospitalization Costs Among African American And Hispanic Patients In Southeastern Virginia, Ismail El Moudden, Asra Amidi, Reem Sharaf-Alddin, Michael C. Bittner, Qi Zhang

Department of Obstetrics & Gynecology Faculty Publications

Background

Diabetes mellitus (DM) imposes substantial healthcare costs with documented disparities among African Americans and Hispanic patients. To inform care delivery and resource allocation, this study identified hospitalization cost predictors among African American and Hispanic patients with diabetes in Southeastern Virginia.

Methods

We analyzed 6,011 hospital discharges from the Virginia Health Information database (2016-2020) for adults aged 18-85 with diabetes. Discharges were classified by Medicare Severity Diagnosis-Related Groups: DM with complications/comorbidities (DCC, n = 3,328), DM with major complications/comorbidities (DMCC, n = 1,518), and DM without major complications/comorbidities (DWO, n = 1,165). Because cost distributions were right-skewed (skewness 3.5-8.24), we …