Epidemiology Commons^™

Associations Between Water Intake, Dietary Quality, And Beverage Consumption Among University Students, Mohammad A. Qazi

Electronic Theses, Projects, and Dissertations

Title: Associations Between Water Intake, Dietary Quality, and Beverage Consumption Among University Students

Background and Aims: Sugar-sweetened beverage (SSB) and ultra-processed food (UPF) consumption significantly contribute to chronic disease risk and is often more common in underserved and racially/ethnically diverse communities. Drinking water is a low-cost, calorie-free behavior that may support healthier beverage and dietary patterns. Previous studies show that increased daily water consumption positively correlates with better diet quality and is inversely correlated with SSB and UPF consumption. This study aims to examine whether (1) increased daily water intake is associated with self-reported diet quality and (2) self-reported hydration …

The Quantification Of Fluoride Water Quality And Its Significance On Oral Health, Harleen Kaur Maroak

Electronic Theses, Projects, and Dissertations

Fluoride is a naturally occurring mineral and studies have shown that when added to community water supplies, it effectively reduces dental caries. According to the U.S. Public Health Services (PHS), 0.7mg/L is the optimal fluoride level in drinking water to prevent tooth decay. This study focuses on examining the fluoride levels in water in San Bernardino County (SBC) and Riverside County (RC). Data is collected from recently published articles, databases along with assessing the laboratory water sample (n=45) analysis to determine if the fluoride levels are meeting the optimal standards. In SBC, there are total of 154 water systems with …

Prevention Of Dementia Using Mobile Phone Applications (Prodemos) – A Health-Economic Cost-Utility Analysis In People Aged 55–75 Years With Low Socio-Economic Status, Ron Handels, Marieke Hoevenaar-Blom, Manshu Song, Carol Brayne, Eric Moll Van Charante, Fiona E. Matthews, Junfang Xu, Linus Jönsson, Nicola Coley, Rachael Brooks, Xuening Jian, Tingting Qin, Youxin Wang, Wei Wang, Edo Richard, Anders Wimo

Research outputs 2022 to 2026

Introduction We aimed to explore the potential incremental cost-effectiveness of the PRODEMOS coach-supported mobile health intervention for primary prevention of dementia versus standard of care provided to people aged 55–75 years with low socio-economic status (SES) in the United Kingdom (UK), and any SES in China. Methods 12–18-month PRODEMOS trial (ISRCTN15986016) efficacy outcomes on hypertension, obesity, hypercholesterolemia, physical inactivity and smoking were extrapolated to lifetime impact on dementia onset, myocardial infarction, stroke and death using a health-economic open-source simulation model. Results Simulated outcomes showed dementia cases were avoided (UK = -206 (-658 to 281), China = -140 (-456 to 205) …

Oral Health Behaviors And Oral Health Status In Elementary School Children In East Kalimantan, Indonesia, Lia Hapsari Andayani, Amabelle Elisanditya, Abdul Gani Soulisa, Sri Lestari

Journal of Dentistry Indonesia

Background: Children's oral health can be influenced by various factors, including health behaviors, dietary patterns, and oral health knowledge. This study aimed to determine the correlation between oral health behaviors and oral health status in elementary school children.

Methods: This cross-sectional study involved 182 elementary school children in Bontang, East Kalimantan, taken by convenience sampling. Health behavior data were acquired by 12-item questionnaires based on the WHO guideline. Examination of dental and oral health status was done by using the DMFT Index and OHI-S. Chi-square was used to determine the correlation between oral health behaviors and oral health …

The Role Of Dollar Store Proliferation In Influencing Diabetes And Obesity Rates In West Virginia, Kelli L. Keith

Walden Dissertations and Doctoral Studies

Dollar stores are the fastest growing food retail format and are highly concentrated in rural, low-income communities including West Virginia, where diabetes and obesity prevalence rank among the highest in the United States. Although these retailers increase physical access to food, concerns remain about their limited healthier food options and potential contribution to chronic disease disparities. Guided by the socioecological model, this three-manuscript dissertation examined how dollar store density and healthier food availability related to county-level diabetes and obesity prevalence in West Virginia. Manuscript 1 used a cross-sectional ecological design with all 55 West Virginia counties, using data from USDA, …

Mechanisms Of Binding And Immune Escape Resistance For Broadly Neutralizing Antibodies Targeting Distinct Conserved Sars-Cov-2 Spike Epitopes: A Hierarchical Approach Integrating Mutational Profiling And Energy Landscape Analysis, Mohammed Alshahrani, Will Gatlin, Max Ludwick, Lucas Turano, Brandon Foley, Gennady M. Verkhivker

Mathematics, Physics, and Computer Science Faculty Articles and Research

The continued evolution of SARS-CoV-2 has enabled an escape from most monoclonal antibodies, yet a subset of broadly neutralizing antibodies targeting three newly identified super-conserved RBD epitopes—SCORE-A, SCORE-B, and SCORE-C—retains remarkable activity against even the most recent JN.1-derived sublineages. Here, we employed an integrated computational framework combining conformational dynamics, mutational scanning, MM-GBSA binding energetics, and frustration profiling to dissect the molecular mechanisms by which XGI antibodies achieve broad neutralization and resistance to immune escape. Structural analysis revealed that all three SCORE epitopes share a common architecture: a highly conserved, minimally frustrated core that provides stable anchoring, flanked by peripheral regions …

Spatial Distribution Patterns Of Determinants Of Hypertension In West Java In 2023, Meirina Nur Asih Susanti, Wahyu Septiono

Preventia: The Indonesian Journal of Public Health

Hypertension is a public health issue that is unevenly distributed across regions. The high prevalence in West Java (34.4%) with a large population makes the management of hypertension crucial. Differences in economic and environmental conditions are thought to influence the distribution of hypertension, thus requiring spatial analysis. This study used an ecological approach by analyzing data from districts/cities in West Java in 2023. Secondary data were used to measure hypertension prevalence and to assess socioeconomic and environmental factors. The analysis was conducted using univariate Moran's Index, Local Indicators of Spatial Association (LISA), and the Spatial Autoregressive Model (SAR). The prevalence …

Using Geospatial Environmental And Income Variables As Predictors Of Diabetes In Appalachia, John Kunicki Huth

Walden Dissertations and Doctoral Studies

Diabetes remains disproportionately prevalent in Appalachia, and macroenvironmental contributors remain poorly understood. Guided by spatial epidemiology, this quantitative, cross-sectional ecological study examined whether county-level environmental factors including distance to mine, distance to landfill, distance to water, mean annual precipitation, mean annual temperature, forest classification, distance to impervious surface, and median income were independently and collectively associated with diabetes cases per capita in West Virginia, used as a surrogate for Appalachia. Research questions addressed environmental predictors of diabetes cases per capita with and without controlling for median income. Publicly available county-level data from 53 West Virginia counties representing adults aged 20 …

Long Work Hours, Suboptimal Diabetes Management, And Differences By Sex And Race/Ethnicity, Nhanes (2011-2018), Tailisha Gonzalez, Margrethe Horlyck-Romanovsky, Terry T.-K. Huang, Sandra E. Echeverria

Publications and Research

In the United States (US), occupational segregation by sex and race/ethnicity can contribute to health disparities. Although work schedule characteristics have been previously linked to elevated cardiovascular risk, little is known about the effects on chronic disease management in women and minoritized workers. We examined the association between work hours and diabetes management among US workers, testing for differences by sex and race/ethnicity. We utilized 2011–2018 National Health and Nutrition Examination Survey (NHANES) data on working adults (age ≥20 years) with diagnosed diabetes (n = 1041). Suboptimal diabetes management was defined as HbA1c ≥7%. Work hours were categorized per WHO …

Infective Endocarditis Hospitalizations In Kentucky, 2008-2018: Spatial And Temporal Trends, Meera Marji, Steve Browning, W. Jay Christian, Richard Charnigo, Steve W. Leung, Anna Kucharska-Newton

Journal of Appalachian Health

Introduction: Infective endocarditis (IE) hospitalization rates have increased significantly in the last decade, primarily due to the opioid epidemic. In 2016, Kentucky (KY) ranked among the top ten states for opioid-related overdose deaths, but limited data exist on IE trends in KY.

Purpose: This study seeks to examine county-level spatial and temporal trends in IE hospitalization rates in KY.

Methods: Hospital inpatient discharge data from 2008–2018 for KY residents aged 18 and older were analyzed. IE admissions and drug use status were identified using ICD-9 & 10 diagnosis codes. U.S. Census data calculated yearly IE hospitalization rates per 100,000 residents. …

Acute Compartment Syndrome Following Lower Leg Vascular Injury: A Big-Data Approach To Estimating Incidence And Risk Factors, Harry Moroz, Edward J. Harvey, Yasser C. Bouklouch

Journal of Shock and Hemodynamics

Acute Compartment Syndrome (ACS) is a limb- and life-threatening complication of lower leg fractures. Rapid recognition and fasciotomy can prevent irreversible ischemic injury, but ACS is often under-recognized. Vascular injury may increase the risk of ACS by impairing perfusion and exacerbating swelling. This study aimed to determine the incidence, risk factors, and outcomes of ACS in patients with lower leg fractures, with particular emphasis on the impact of vascular injury. This retrospective cohort study used data from the 2017 American College of Surgeons Trauma Quality Programs database to perform a multicenter analysis of patients with lower leg fractures. Patients were …

Health Data And Policy Related To Methamphetamine-Use Suicide In Mississippi, Mary C. Drane

Honors Theses

The purpose of this research is to investigate how methamphetamine use in Mississippi, especially in its rural areas, intersects with public health, policy, and suicide outcomes in the state. Mississippi's methamphetamine crisis has evolved significantly, shifting from locally produced drugs to cartel-supplied crystal methamphetamine, while state and federal policies have struggled to keep pace with the scale and complexity of the problem. Using a convergent parallel mixed-methods design, this research analyzed CDC Wonder multiple causes of death data and SAMHSA Treatment Episode Data Set Admissions (TEDS-A) data from 2018 to 2024 alongside four qualitative key informant interviews with stakeholders across …

Connectivity, Classroom, And Contagion: An Ecological Analysis Of Testing Availability, Sex Education, And Sti Rates In The Upper Midwest, Macey M. Boerhave

Honors Thesis

Rural and frontier communities in the Upper Midwest face unique challenges that shape how young people access sexual health information and testing. While sexually transmitted infection (STI) rates continue to rise nationally, less is known about how sexual health education, digital access, and geographic distance influence these trends at a county level. This study examines the relationship between broadband internet access rates, poverty rates, proximity to free or low-cost STI testing sites, and county-level STI rates among individuals aged 15-24 in selected counties across South Dakota, North Dakota, Minnesota, Iowa, and Nebraska. Using an ecological, cross-sectional design, county-level STI surveillance …

Relationship Between Hepatitis B Virus Screening, Vaccination, And Spread In Sierra Leone, Muhammed Sarmodu Mansaray

Walden Dissertations and Doctoral Studies

Hepatitis B virus (HBV) presents a significant public health burden in Sierra Leone. Although the estimated prevalence was 8.7% in 2021, comprehensive statistical data has been limited in general. Programmatic interventions for HBV control such as systematic screening and vaccination have remained limited as well. The purpose of this quantitative cross-sectional study was to examine the relationship between screening and vaccination practices and HBV prevalence in Sierra Leone while controlling for age, sex, education and health care access. The theoretical framework incorporated the Integrated Screening Action model, which highlights screening as a critical disease prevention strategy, and the Social Ecological …

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 …

Obesity In The Rio Grande Valley: Applying An Evidence-Based Public Health Approach, Erika Pineda-Horta

Posters - 2026

What structural and social determinants drive elevated adult obesity rates in the Rio Grande Valley, and what evidence-based interventions can reduce adult obesity prevalence in Hidalgo County by 5% by 2030?

Objective: This study applies an EBPH framework to (1) characterize the burden and structural determinants of adult obesity in the RGV, and (2) propose a culturally responsive, evidence-based intervention targeting adults aged 18+ in Hidalgo County.

Adult obesity is clinically defined as a Body Mass Index (BMI) ≥30 kg/m² in adults aged 18 and older (CDC, 2022). It is a chronic, multifactorial non-communicable disease shaped by structural, social, and …

Visits Related To Alcohol, Substance Use, And Mental Health In New Mexico’S Emergency Departments: Social Determinants Of Health And Discharge Disposition, 2021-2024, Samuel L. Swift, Maya Stefanovic, Dylan Pell

Population Health Research and Scholarship

No abstract provided.

Factors Associated With Lapses In Care Among People Living With Hiv In South Carolina, Xueying Yang Ph.D., Fanghui Shi, Shujie Chen, Gavi Samuel, Bankole Olatosi Ph.D., Sharon Weissman, Xiaoming Li Ph.D., Jiajia Zhang Ph.D.

Faculty Publications

Utilizing statewide electronic health records (EHR) data, this study aims to assess the factors determining the occurrence of lapses in HIV care among people with HIV (PWH) in South Carolina (SC). All adult (≥ 18 years old) PWH who were diagnosed with HIV between 2006 and 2018 with at least two HIV care encounters and at least 1-year follow-up record were included in the analysis. The outcome, a lapse in care, was defined as a repeated measure of HIV care encounter that occurs over a year following the previous visit. Generalized Estimation Equation models were employed. The study cohort had …

Occupational Epidemiology Of Acral Lentiginous Melanoma, Lily Guo, Robin Kikuchi, April W. Armstrong, Suephy C. Chen

Department of Dermatology and Cutaneous Biology Faculty Papers

Acral lentiginous melanoma (ALM) classically presents in glabrous skin. Some studies suggest an association between mechanical stress and ALM development. People working jobs with long periods of standing/walking may be exposed to near-daily mechanical stress. To investigate the relationship between occupation type and ALM development, we performed a retrospective cohort study using Optum’s Clinformatics Database (2007—2023). We compared the risk of ALM in adults with occupational data (n = 9,270,935). Retired patients had the highest prevalence (0.081) and incidence per 1,000,000 person-years (0.514, 95% confidence interval = 0.487—0.542) of ALM. We performed multivariate logistic regression, adjusted for demographics and insurance, …

Implementation And Costs Of A Food Insecurity Resource Navigation Program For Primary Care Patients With Diabetes And Hypertension In South Carolina, Deeksha Gupta, Darin Thomas, Stella Coker Watson Self Ph.D., Ms, Edward A. Frongillo Jr. Ph.D., Alain H. Litwin, Joseph A. Ewing, Lynnette Ramos-Gonzalez, Lynnette Ramos-Gonzalez

Faculty Publications

Objective

To examine food insecurity resource navigation program costs and how navigation intensity relates to clinical outcomes, healthcare costs, and quality of life (QOL) for diabetes and/or hypertension patients.

Methods

This retrospective study included patients receiving resource navigation (July 12, 2021-December 31, 2022 with twelve-month follow-up) across three primary care practices in South Carolina's largest health system. Participants were 18+ years old (from electronic medical records/Epic), had food insecurity (from Hunger Vital Sign™), and diabetes and/or hypertension (from Epic registries). Matched controls came from food insecurity screening-only practices. Patients in each group (n= 219) had diabetes (9.13%), hypertension …

Preoperative Health During A Pandemic: An Observational Study Assessing Lifestyle Changes In Patients Associated With Covid-19 In Western Australia, Nadine Radin, Dana Hince, Jim Codde, Paola Chivers, Dale W. Edgar

Research outputs 2022 to 2026

Background and Aim: Healthcare service disruptions resulting from the COVID-19 pandemic led to substantial changes in surgical pathways across public hospitals in Western Australia (WA). These disruptions, compounded by restrictions and containment measures, influenced the health and lifestyle behaviours of the WA community, including patients awaiting surgery. This study aimed to assess changes in self-reported modifiable lifestyle risk factors among patients during COVID-19. Methods: This observational study analysed hospital patient data across three seasonally matched calendar periods: Period 1 (January–March 2019 vs 2020), Period 2 (March–July 2019 vs 2020), and Period 3 (July–December 2019 vs 2020). Multivariable regression models were …

Impact Of Cannabis And Cannabis Legalization On Us Atrial Septal Defect Rates, Albert Stuart Reece, Hulse

Research outputs 2022 to 2026

Atrial septal defect (ASD) affects 1:11.3 children in some US states; however, the antecedents of these trends are yet to be identified. A total of 1882 ASD rates (ASDRs) for 2003–2020 were sourced from the National Birth Defects Prevention Network reports. A total of 406,893 ASDs are reported. Substance (cigarettes, binge alcohol, cannabis, cannabinoids, analgesics, cocaine) exposure data were taken from the National Survey of Drug Use and Health. Income and ethnicity data were derived from the US Census. Adjustment was performed by mixed effects, survey and generalized additive regression. Causal analysis was by inverse probability weighting and E-values. Data …

Space-Time Analysis Of Burgeoning Us Atrial Septal Defect Rates Driven By Cannabis, Albert Stuart Reece, Kenneth Hulse

Research outputs 2022 to 2026

Atrial septal defect (ASD) has become increasingly common in the USA and now affects 1 in 11.3 children in some places, but space–time analysis has not been applied to this emerging trend. ASD rate (ASDR) data were obtained from the National Birth Defects Prevention Network 2003–2020. Substance (cigarettes, alcohol, cannabis, analgesics, cocaine) use data were obtained from the National Survey of Drug Use and Health. Income data were obtained from the US Census. Analysis was limited to the Non-Hispanic White population by technical factors. Time-sequential univariate and bivariate maps were prepared for both covariates and outcomes and their combinations. Spatial …

Longitudinal Assessment Of Health-Related Quality Of Life In Adults With Ckd, Owen Ng, Teixeira-Pinto, Anh Kieu, Anita Van Zwieten, Anoushka Krishnan, Kirsten Howard, Wai H. Lim, Jeremy R. Chapman, Simon D. Roger, Michael J. Bourke, Shaundeep Sen, Steven J. Chadban, Carol A. Pollock, Allison Jaure, Jonathan C. Craig, Jean Yang, Germaine Wong

Research outputs 2022 to 2026

Key Points: Dialysis linked with poorer quality of life compared with transplant patients and patients with CKD. Quality of life trends were similar in both domain-specific and overall quality-of-life measures. Background: There are sparse data about the change in health-related quality of life (HRQoL) with the temporal progression of CKD. In this study, we assessed the association between change in CKD stages, overall and domain-specific quality of life and determined the factors that were associated with this change. Methods: Data were sourced from a multicenter study that included 1290 adult patients aged 18 years and older across six centers in …

Combined Effect Of Sarcopenia And Impaired Respiratory Function On All-Cause Death: A Nationwide Cohort Study, Chutao Wu, Dan Wu, Mu Li, Senrong Lu, Yukai Wang, Yulong Lan

Research outputs 2022 to 2026

Background: Respiratory fitness and sarcopenia status have been reported to be cross-sectionally linked with each other and increase mortality risk. However, little is currently known regarding the connection between impaired respiratory function and sarcopenia and their joint effect on future death risk. Methods: This study included 12 027 participants (50.8% were women; mean [SD] age, 58.9 [9.3] years) from a nationwide, prospective cohort in China (China Health and Retirement Longitudinal Study). Respiratory function was assessed by peak expiratory flow (PEF). Sarcopenia status was assessed according to the Asian Working Group for Sarcopenia 2019 (AWGS 2019) criteria. Time-to-event survival analyses and …

Aircraft Wastewater Surveillance As A Tool For Monitoring Disease In The Pacific, Carla J. Eaton, Joanne R. Chapman, Brent J. Gilpin

Pacific Journal of Health

Wastewater surveillance is a powerful tool for monitoring infectious diseases within a population. However, as most wastewater surveillance relies on interconnected wastewater networks to provide samples representative of the population, many Pacific Islands have been excluded from benefiting from this tool due to their lack of reticulated sewerage systems. Many diseases of concern for the Pacific are detectable in wastewater even though individuals may be asymptomatic. We investigated whether analysis of wastewater from aircraft arriving in New Zealand from Pacific Island nations could be used as a proxy for in-country surveillance. Flights from the Pacific arrive in Auckland daily, with …

Characteristics Of Leprosy Chemoprophylaxis Recipeints In The Tirtayasa Public Health Center Area, 2023–2024, Rifa Imaroh, Maria Angela Lumaksono, Izzah Imani, Dhelya Widasmara

Jurnal Epidemiologi Kesehatan Indonesia

Leprosy remains a public health problem in Indonesia. In 2023, Indonesia ranked third globally in the number of leprosy cases, with 14,376 reported cases, after India (107,851 cases) and Brazil (22,773 cases). One of the key strategies for leprosy control in Indonesia is the implementation of preventive measures, including home visits and the administration of chemoprophylaxis using single-dose rifampicin (SDR). Post-exposure prophylaxis plays an important role in preventing leprosy transmission among contacts of confirmed patients. This study aimed to describe the characteristics of leprosy chemoprophylaxis recipients in the Tirtayasa Public Health Center area during 2023–2024. This study was an descriptive …

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 …

The Blurred Boundaries Of Care: A Qualitative Analysis Of Nurse-Doula Role Conflict, Curisa Mae Tucker Phd, Rn, Maria Mcclam, Kelly Russin Dnp, Rnc-Ob, Chse, Nansi Boghossian, Rachel Gulczinski, Lauren Workman

Faculty Publications

Introduction:

Methods: