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Madera-Garcia V, Soto JR, Ellingson KD, Jacobs E, Walker KR, Ernst KC. Preferences and Demand for Mosquito Control among Dengue-Endemic Communities in Peñuelas, Puerto Rico: An Application of the Best-Worst Choice Model. Am J Trop Med Hyg 2024; 110:540-548. [PMID: 38266284 PMCID: PMC10919196 DOI: 10.4269/ajtmh.22-0528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 07/25/2023] [Indexed: 01/26/2024] Open
Abstract
Aedes aegypti is the primary vector of dengue virus and threatens 3.9 billion people living in many tropical and subtropical countries. Prevention and reduction of dengue and other Aedes-borne viruses, including Zika and chikungunya, requires control of mosquito populations. Community mobilization and input are essential components of vector control efforts. Many vector control campaigns do not engage communities prior to implementation, leading to program failure. Those that do often conduct basic knowledge, attitude, and practice surveys that are not designed to explicitly elicit preferences. Here, we applied a novel stated preference elicitation tool, best-worst choice, to understand preferences, willingness to participate, and willingness to pay for mosquito control in dengue-endemic communities of Peñuelas, Puerto Rico. Findings revealed that the community preferred mosquito control programs that are 1) applied at the neighborhood level, 2) implemented by the local government, and 3) focused specifically on reducing disease transmission (e.g., dengue) instead of mosquito nuisance. Programs targeting the reduction of disease transmission and higher educational level of participants increased willingness to participate. Participants were willing to pay an average of $72 annually to have a program targeting the reduction of diseases such as dengue. This study serves as a model to engage communities in the design of mosquito control programs and improve stakeholders' decision-making.
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Affiliation(s)
| | - José R. Soto
- School of Natural Resources and the Environment, University of Arizona, Tucson, Arizona
| | | | - Elizabeth Jacobs
- College of Public Health, University of Arizona, Tucson, Arizona
- Arizona Cancer Center, University of Arizona, Tucson, Arizona
| | | | - Kacey C. Ernst
- College of Public Health, University of Arizona, Tucson, Arizona
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Liu RW, Cheng Y, Barbati JL, Rains SA, Crane TE, Ernst KC. The Effectiveness of Social Norm Appeals on Promoting COVID-19 Prevention Behaviors: A Multistudy Examination. Health Commun 2023:1-9. [PMID: 37981578 DOI: 10.1080/10410236.2023.2284493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
Recent research shows social norm perceptions predict people's adherence to COVID-19 preventative health practices. Nonetheless, additional empirical studies are necessary to evaluate the effectiveness of different types of social norm messages on behavioral outcomes with experimental designs. Guided by the social norm literature and frameworks, the current research addresses this need by examining the effects of descriptive and injunctive norm appeals promoting the practice of social distancing and mask-wearing with both a controlled experiment and social media campaigns. Results from this multistudy investigation showed the effectiveness of descriptive and injunctive norm messages (v. no message exposure) in promoting focal behaviors and highlighted the superiority of injunctive norm appeals in promoting behavioral intentions and increasing social media engagement. Theoretical implications and recommendations for practice are discussed.
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Affiliation(s)
- Rain Wuyu Liu
- Department of Communication, The University of Arizona
| | - Ying Cheng
- Department of Management, California State University San Bernardino
| | | | | | - Tracy E Crane
- Division of Medical Oncology, Miller School of Medicine, University of Miami
| | - Kacey C Ernst
- Department of Epidemiology and Biostatistics, Zuckerman College of Public Health, The University of Arizona
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Coalson JE, Richard DM, Hayden MH, Townsend J, Damian D, Smith K, Monaghan A, Ernst KC. Aedes aegypti abundance in urban neighborhoods of Maricopa County, Arizona, is linked to increasing socioeconomic status and tree cover. Parasit Vectors 2023; 16:351. [PMID: 37807069 PMCID: PMC10560435 DOI: 10.1186/s13071-023-05966-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 09/09/2023] [Indexed: 10/10/2023] Open
Abstract
BACKGROUND Understanding coupled human-environment factors which promote Aedes aegypti abundance is critical to preventing the spread of Zika, chikungunya, yellow fever and dengue viruses. High temperatures and aridity theoretically make arid lands inhospitable for Ae. aegypti mosquitoes, yet their populations are well established in many desert cities. METHODS We investigated associations between socioeconomic and built environment factors and Ae. aegypti abundance in Maricopa County, Arizona, home to Phoenix metropolitan area. Maricopa County Environmental Services conducts weekly mosquito surveillance with CO2-baited Encephalitis Vector Survey or BG-Sentinel traps at > 850 locations throughout the county. Counts of adult female Ae. aegypti from 2014 to 2017 were joined with US Census data, precipitation and temperature data, and 2015 land cover from high-resolution (1 m) aerial images from the National Agricultural Imagery Program. RESULTS From 139,729 trap-nights, 107,116 Ae. aegypti females were captured. Counts were significantly positively associated with higher socioeconomic status. This association was partially explained by higher densities of non-native landscaping in wealthier neighborhoods; a 1% increase in the density of tree cover around the trap was associated with a ~ 7% higher count of Ae. aegypti (95% CI: 6-9%). CONCLUSIONS Many models predict that climate change will drive aridification in some heavily populated regions, including those where Ae. aegypti are widespread. City climate change adaptation plans often include green spaces and vegetation cover to increase resilience to extreme heat, but these may unintentionally create hospitable microclimates for Ae. aegypti. This possible outcome should be addressed to reduce the potential for outbreaks of Aedes-borne diseases in desert cities.
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Affiliation(s)
- Jenna E Coalson
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA.
| | - Danielle M Richard
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Mary H Hayden
- Lyda Hill Institute for Human Resilience, University of Colorado, Colorado Springs, CO, USA
| | - John Townsend
- Maricopa County, Environmental Services Department, Vector Control Division, Phoenix, AZ, USA
| | - Dan Damian
- Maricopa County, Environmental Services Department, Vector Control Division, Phoenix, AZ, USA
| | - Kirk Smith
- Maricopa County, Environmental Services Department, Vector Control Division, Phoenix, AZ, USA
| | | | - Kacey C Ernst
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
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Jacobs ET, Cordova-Marks FM, Farland LV, Ernst KC, Andrews JG, Vu S, Heslin KM, Catalfamo C, Chen Z, Pogreba-Brown K. Understanding low COVID-19 booster uptake among US adults. Vaccine 2023; 41:6221-6226. [PMID: 37666694 DOI: 10.1016/j.vaccine.2023.08.080] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Revised: 08/28/2023] [Accepted: 08/29/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND Vaccinations against SARS-CoV-2 have consistently been shown to reduce the risk of severe COVID-19 disease. However, uptake of boosters has stalled in the United States at less than 20% of the eligible population. The objective of this study was to assess the reasons for not having obtained a bivalent booster within an existing COVID-19 cohort. METHODS A total of 2196 adult participants from the Arizona CoVHORT, a population-based cohort in the United States established in May 2020, who had received at least one dose of the COVID-19 vaccine, responded to surveys administered between February 13 and March 29, 2023 querying receipt of a bivalent booster and if not, the reasons for not receiving it. Descriptive statistics were employed, including frequencies of responses by participant characteristics, and multivariable logistic regression was used to assess the association between participant characteristics and selected themes for not having received the bivalent booster. RESULTS The most commonly reported reason for not having been boosted was a prior SARS-CoV-2 infection (39.5%), followed by concern about vaccine side effects (31.5%), believing that the booster would not provide additional protection over the vaccines already received (28.6%), and concern about booster safety (23.4%) or that it would not protect from SARS-CoV-2 infection (23.1%). For themes related to reasons for not having been boosted, those 60 years of age or older were less likely to select items related to knowledge (OR: 0.24; 95% CI: 0.11-0.55) or logistical concerns (OR: 0.09; 95% CI: 0.03-0.30) about the vaccine; while those reporting Hispanic ethnicity were more likely to convey concerns about logistics than those reporting non-Hispanic ethnicity (OR: 2.15; 95% CI: 1.08-4.30). Finally, compared to college graduates, those with some college or technical school were significantly more likely to select items related to the risks and benefits of the bivalent vaccine not being clear as reasons for not having been boosted (OR: 2.41; 95% CI: 1.69-3.43). CONCLUSIONS Improvement in booster uptake is necessary for optimal public health in the United States. The development of vaccines against SARS-CoV-2 occurred at an unprecedented speed, but vaccine uptake remains among the greatest current public health challenges as updated boosters continue to be developed and made available to the public. Interventions to improve vaccination rates require a variety of approaches.
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Affiliation(s)
- Elizabeth T Jacobs
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States.
| | - Felina M Cordova-Marks
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Leslie V Farland
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Kacey C Ernst
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Jennifer G Andrews
- Department of Pediatrics, College of Medicine, University of Arizona, Tucson, AZ, United States
| | - Sage Vu
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Kelly M Heslin
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Collin Catalfamo
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Zhao Chen
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Kristen Pogreba-Brown
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
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Thaweethai T, Jolley SE, Karlson EW, Levitan EB, Levy B, McComsey GA, McCorkell L, Nadkarni GN, Parthasarathy S, Singh U, Walker TA, Selvaggi CA, Shinnick DJ, Schulte CCM, Atchley-Challenner R, Alba GA, Alicic R, Altman N, Anglin K, Argueta U, Ashktorab H, Baslet G, Bassett IV, Bateman L, Bedi B, Bhattacharyya S, Bind MA, Blomkalns AL, Bonilla H, Bush PA, Castro M, Chan J, Charney AW, Chen P, Chibnik LB, Chu HY, Clifton RG, Costantine MM, Cribbs SK, Davila Nieves SI, Deeks SG, Duven A, Emery IF, Erdmann N, Erlandson KM, Ernst KC, Farah-Abraham R, Farner CE, Feuerriegel EM, Fleurimont J, Fonseca V, Franko N, Gainer V, Gander JC, Gardner EM, Geng LN, Gibson KS, Go M, Goldman JD, Grebe H, Greenway FL, Habli M, Hafner J, Han JE, Hanson KA, Heath J, Hernandez C, Hess R, Hodder SL, Hoffman MK, Hoover SE, Huang B, Hughes BL, Jagannathan P, John J, Jordan MR, Katz SD, Kaufman ES, Kelly JD, Kelly SW, Kemp MM, Kirwan JP, Klein JD, Knox KS, Krishnan JA, Kumar A, Laiyemo AO, Lambert AA, Lanca M, Lee-Iannotti JK, Logarbo BP, Longo MT, Luciano CA, Lutrick K, Maley JH, Marathe JG, Marconi V, Marshall GD, Martin CF, Matusov Y, Mehari A, Mendez-Figueroa H, Mermelstein R, Metz TD, Morse R, Mosier J, Mouchati C, Mullington J, Murphy SN, Neuman RB, Nikolich JZ, Ofotokun I, Ojemakinde E, Palatnik A, Palomares K, Parimon T, Parry S, Patterson JE, Patterson TF, Patzer RE, Peluso MJ, Pemu P, Pettker CM, Plunkett BA, Pogreba-Brown K, Poppas A, Quigley JG, Reddy U, Reece R, Reeder H, Reeves WB, Reiman EM, Rischard F, Rosand J, Rouse DJ, Ruff A, Saade G, Sandoval GJ, Schlater SM, Shepherd F, Sherif ZA, Simhan H, Singer NG, Skupski DW, Sowles A, Sparks JA, Sukhera FI, Taylor BS, Teunis L, Thomas RJ, Thorp JM, Thuluvath P, Ticotsky A, Tita AT, Tuttle KR, Urdaneta AE, Valdivieso D, VanWagoner TM, Vasey A, Verduzco-Gutierrez M, Wallace ZS, Ward HD, Warren DE, Weiner SJ, Welch S, Whiteheart SW, Wiley Z, Wisnivesky JP, Yee LM, Zisis S, Horwitz LI, Foulkes AS. Development of a Definition of Postacute Sequelae of SARS-CoV-2 Infection. JAMA 2023; 329:1934-1946. [PMID: 37278994 PMCID: PMC10214179 DOI: 10.1001/jama.2023.8823] [Citation(s) in RCA: 152] [Impact Index Per Article: 152.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 05/01/2023] [Indexed: 06/07/2023]
Abstract
Importance SARS-CoV-2 infection is associated with persistent, relapsing, or new symptoms or other health effects occurring after acute infection, termed postacute sequelae of SARS-CoV-2 infection (PASC), also known as long COVID. Characterizing PASC requires analysis of prospectively and uniformly collected data from diverse uninfected and infected individuals. Objective To develop a definition of PASC using self-reported symptoms and describe PASC frequencies across cohorts, vaccination status, and number of infections. Design, Setting, and Participants Prospective observational cohort study of adults with and without SARS-CoV-2 infection at 85 enrolling sites (hospitals, health centers, community organizations) located in 33 states plus Washington, DC, and Puerto Rico. Participants who were enrolled in the RECOVER adult cohort before April 10, 2023, completed a symptom survey 6 months or more after acute symptom onset or test date. Selection included population-based, volunteer, and convenience sampling. Exposure SARS-CoV-2 infection. Main Outcomes and Measures PASC and 44 participant-reported symptoms (with severity thresholds). Results A total of 9764 participants (89% SARS-CoV-2 infected; 71% female; 16% Hispanic/Latino; 15% non-Hispanic Black; median age, 47 years [IQR, 35-60]) met selection criteria. Adjusted odds ratios were 1.5 or greater (infected vs uninfected participants) for 37 symptoms. Symptoms contributing to PASC score included postexertional malaise, fatigue, brain fog, dizziness, gastrointestinal symptoms, palpitations, changes in sexual desire or capacity, loss of or change in smell or taste, thirst, chronic cough, chest pain, and abnormal movements. Among 2231 participants first infected on or after December 1, 2021, and enrolled within 30 days of infection, 224 (10% [95% CI, 8.8%-11%]) were PASC positive at 6 months. Conclusions and Relevance A definition of PASC was developed based on symptoms in a prospective cohort study. As a first step to providing a framework for other investigations, iterative refinement that further incorporates other clinical features is needed to support actionable definitions of PASC.
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Affiliation(s)
- Tanayott Thaweethai
- Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | | | | | | | - Bruce Levy
- Harvard Medical School, Boston, Massachusetts
- Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Lisa McCorkell
- Patient-Led Research Collaborative, Calabasas, California
| | | | | | - Upinder Singh
- Stanford University School of Medicine, Stanford, California
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Mario Castro
- University of Kansas Medical Center, Kansas City
| | | | | | - Peter Chen
- Cedars-Sinai Medical Center, Los Angeles, California
| | | | - Helen Y Chu
- University of Washington School of Medicine, Seattle
| | | | | | | | | | | | | | | | | | | | | | | | - Cheryl E Farner
- The University of Texas Health Science Center at San Antonio
| | | | | | - Vivian Fonseca
- Tulane University Health Sciences Center, New Orleans, Louisiana
| | | | | | | | | | | | | | - Minjoung Go
- Stanford University School of Medicine, Stanford, California
| | | | | | | | | | - John Hafner
- University of Illinois Chicago College of Medicine
| | - Jenny E Han
- Emory University School of Medicine, Atlanta, Georgia
| | | | - James Heath
- Institute for Systems Biology, Seattle, Washington
| | | | - Rachel Hess
- University of Utah Schools of the Health Sciences, Salt Lake City
| | - Sally L Hodder
- West Virginia Clinical and Translational Science Institute, Morgantown
| | | | | | | | | | | | - Janice John
- Cambridge Health Alliance, Cambridge, Massachusetts
| | | | - Stuart D Katz
- New York University Grossman School of Medicine, New York
| | | | | | - Sara W Kelly
- University of Illinois College of Medicine at Peoria
| | | | - John P Kirwan
- Pennington Biomedical Research Center, Baton Rouge, Louisiana
| | | | | | - Jerry A Krishnan
- University of Illinois Hospital and Health Sciences System, Chicago
| | - Andre Kumar
- Stanford University School of Medicine, Stanford, California
| | | | | | | | | | | | | | | | | | - Jason H Maley
- Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | | | | | | | | | - Yuri Matusov
- Cedars-Sinai Medical Center, Los Angeles, California
| | - Alem Mehari
- Howard University College of Medicine, Washington, DC
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Jan E Patterson
- The University of Texas Health Science Center at San Antonio
| | | | | | | | | | | | - Beth A Plunkett
- Harvard Medical School, Boston, Massachusetts
- NorthShore University HealthSystem, Evanston, Illinois
| | | | - Athena Poppas
- Warren Alpert Medical School, Brown University, Providence, Rhode Island
| | | | - Uma Reddy
- Columbia University Irving Medical Center, New York, New York
| | - Rebecca Reece
- West Virginia University School of Medicine, Morgantown
| | | | - W B Reeves
- Department of Medicine, The University of Texas Health Science Center at San Antonio
| | | | | | | | | | - Adam Ruff
- The University of Kansas Medical Center, Kansas City
| | | | - Grecio J Sandoval
- Milken Institute of Public Health, The George Washington University, Washington, DC
| | | | | | - Zaki A Sherif
- Howard University College of Medicine, Washington, DC
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Steven J Weiner
- The George Washington University Biostatistics Center, Rockville, Maryland
| | | | | | | | | | - Lynn M Yee
- Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | | | | | - Andrea S Foulkes
- Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
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Ernst KC, Walker KR, Castro-Luque AL, Schmidt C, Joy TK, Brophy M, Reyes-Castro P, Díaz-Caravantes RE, Encinas VO, Aguilera A, Gameros M, Cuevas Ruiz RE, Hayden MH, Alvarez G, Monaghan A, Williamson D, Arnbrister J, Gutiérrez EJ, Carrière Y, Riehle MA. Differences in Longevity and Temperature-Driven Extrinsic Incubation Period Correlate with Varying Dengue Risk in the Arizona–Sonora Desert Region. Viruses 2023; 15:v15040851. [PMID: 37112832 PMCID: PMC10146351 DOI: 10.3390/v15040851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 02/23/2023] [Accepted: 03/01/2023] [Indexed: 03/29/2023] Open
Abstract
Dengue transmission is determined by a complex set of interactions between the environment, Aedes aegypti mosquitoes, dengue viruses, and humans. Emergence in new geographic areas can be unpredictable, with some regions having established mosquito populations for decades without locally acquired transmission. Key factors such as mosquito longevity, temperature-driven extrinsic incubation period (EIP), and vector–human contact can strongly influence the potential for disease transmission. To assess how these factors interact at the edge of the geographical range of dengue virus transmission, we conducted mosquito sampling in multiple urban areas located throughout the Arizona–Sonora desert region during the summer rainy seasons from 2013 to 2015. Mosquito population age structure, reflecting mosquito survivorship, was measured using a combination of parity analysis and relative gene expression of an age-related gene, SCP-1. Bloodmeal analysis was conducted on field collected blood-fed mosquitoes. Site-specific temperature was used to estimate the EIP, and this predicted EIP combined with mosquito age were combined to estimate the abundance of “potential” vectors (i.e., mosquitoes old enough to survive the EIP). Comparisons were made across cities by month and year. The dengue endemic cities Hermosillo and Ciudad Obregon, both in the state of Sonora, Mexico, had higher abundance of potential vectors than non-endemic Nogales, Sonora, Mexico. Interestingly, Tucson, Arizona consistently had a higher estimated abundance of potential vectors than dengue endemic regions of Sonora, Mexico. There were no observed city-level differences in species composition of blood meals. Combined, these data offer insights into the critical factors required for dengue transmission at the ecological edge of the mosquito’s range. However, further research is needed to integrate an understanding of how social and additional environmental factors constrain and enhance dengue transmission in emerging regions.
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Farland LV, Khan SM, Shilen A, Heslin KM, Ishimwe P, Allen AM, Herbst-Kralovetz MM, Mahnert ND, Pogreba-Brown K, Ernst KC, Jacobs ET. COVID-19 vaccination and changes in the menstrual cycle among vaccinated persons. Fertil Steril 2023; 119:392-400. [PMID: 36539055 PMCID: PMC9758067 DOI: 10.1016/j.fertnstert.2022.12.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 12/13/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To describe the characteristics of people who experience changes to their menstrual cycle after COVID-19 vaccination. DESIGN Longitudinal study. PATIENT(S) We recruited a volunteer sample with and without a history of SARS-CoV-2 infection who enrolled in the Arizona COVID-19 Cohort (CoVHORT) study and participated in a reproductive sub-cohort who were pre-menopausal, not pregnant, and had received a COVID-19 vaccine in 2021 (n = 545). EXPOSURE(S) Demographic and reproductive characteristics were collected via self-reports. MAIN OUTCOME MEASURE(S) Information on self-reported changes in the menstrual cycle after COVID-19 vaccination was collected from May 2021 to December 2021. We looked at demographic and reproductive characteristics as predictors of menstrual cycle change. RESULT(S) The majority of our vaccinated sample received the Pfizer-BioNTech vaccine (58%), and were 26-35 years old (51%), non-Hispanic (84%), and White (88%). Approximately 25% of vaccinated participants reported a change in their menstrual cycle after vaccination; the majority reported changes after their second dose (56%) as compared with their first (18%) and third (14%) doses. The most commonly reported changes were irregular menstruation (43%), increased premenstrual symptoms (34%), increased menstrual pain or cramps (30%), and abnormally heavy or prolonged bleeding (31%). High self-reported perceived stress levels compared with low perceived stress (OR, 2.22; 95% CI 1.12-4.37) and greater body mass index (OR, 1.04; 95% CI 1.00-1.07) were associated with greater odds of experiencing the menstrual cycle changes after the vaccination. Participants having a history of SARS-CoV-2 infection were less likely to report changes in their menstrual cycle after vaccination compared with the participants with no history of SARS-CoV-2 infection (OR, 0.58; 95% CI 0.32-1.04). CONCLUSION(S) Among vaccinated participants, approximately 25% of them reported predominantly temporary changes in the menstrual cycle, however, we are unable to determine whether these changes are due to normal cycle variability. The COVID-19 vaccines are safe and effective for everyone, including pregnant people and people trying to conceive; hence, these findings should not discourage vaccination.
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Affiliation(s)
- Leslie V Farland
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona; Department of Obstetrics and Gynecology, College of Medicine-Tucson, University of Arizona; University of Arizona Cancer Center, University of Arizona
| | - Sana M Khan
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona
| | - Alexandra Shilen
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona
| | - Kelly M Heslin
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona
| | - Providence Ishimwe
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona
| | - Alicia M Allen
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona; Department of Family and Community Medicine, College of Medicine-Tucson, University of Arizona
| | - Melissa M Herbst-Kralovetz
- University of Arizona Cancer Center, University of Arizona; Department of Basic Medical Sciences, College of Medicine-Phoenix, University of Arizona; Department of Obstetrics and Gynecology, College of Medicine-Phoenix, University of Arizona
| | - Nichole D Mahnert
- Department of Obstetrics and Gynecology, College of Medicine-Phoenix, University of Arizona
| | - Kristen Pogreba-Brown
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona
| | - Kacey C Ernst
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona
| | - Elizabeth T Jacobs
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona; University of Arizona Cancer Center, University of Arizona.
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Madera-Garcia V, Coalson JE, Subelj M, Bell ML, Hayden MH, Agawo M, Munga S, Ernst KC. Self-Reported Symptoms at Last Febrile Illness as a Predictor of Treatment-Seeking in Western Kenya: A Cross-Sectional Study. Am J Trop Med Hyg 2023; 108:212-220. [PMID: 36410323 PMCID: PMC9833091 DOI: 10.4269/ajtmh.21-0447] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/25/2022] [Indexed: 11/23/2022] Open
Abstract
Timely treatment-seeking behavior can reduce morbidity and mortality due to infectious diseases. Patterns of treatment-seeking behavior can differ by access to health care, and perceptions of disease severity and symptoms. We evaluated the association between self-reported symptoms at last illness and the level of treatment-seeking behaviors. We analyzed cross-sectional data from 1,037 participants from the lowlands and highlands of Western Kenya from 2015 using logistic regression models. There was considerable heterogeneity in the symptoms and treatment-seeking behaviors reported among individuals who were febrile at their last illness. A greater number of self-reported categories of symptoms tended to be associated with a higher likelihood of treatment-seeking in both sites. Participants were significantly more likely to seek treatment if they reported fever, aches, and digestive symptoms at last illness than just fever and aches or fever alone, but the frequency of treatment-seeking for fever in combination with aches and respiratory symptoms did not follow a consistent pattern. Among those who sought treatment, most used a formal source, but the patterns were inconsistent across sites and by the number of symptoms categories. Understanding the drivers of treatment-seeking behavior after febrile illness is important to control and treat infectious diseases in Kenya.
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Affiliation(s)
| | - Jenna E. Coalson
- Eck Institute for Global Health, University of Notre Dame, Notre Dame, Indiana
| | - Maja Subelj
- National Institute of Public Health, University of Ljubljana, Ljubljana, Slovenia
| | - Melanie L. Bell
- College of Public Health, University of Arizona, Tucson, Arizona
| | - Mary H. Hayden
- Lyda Hill Institute for Human Resilience, University of Colorado, Colorado Springs, Colorado
| | - Maurice Agawo
- Kenya Medical Research Institute, Kisian Research Station, Kenya
| | - Stephen Munga
- Kenya Medical Research Institute, Kisian Research Station, Kenya
| | - Kacey C. Ernst
- College of Public Health, University of Arizona, Tucson, Arizona
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9
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Burger JR, Okie JG, Hatton IA, Weinberger VP, Shrestha M, Liedtke KJ, Be T, Cruz AR, Feng X, Hinojo-Hinojo C, Kibria ASMG, Ernst KC, Enquist BJ. Global city densities: Re-examining urban scaling theory. Front Conserv Sci 2022. [DOI: 10.3389/fcosc.2022.879934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Understanding scaling relations of social and environmental attributes of urban systems is necessary for effectively managing cities. Urban scaling theory (UST) has assumed that population density scales positively with city size. We present a new global analysis using a publicly available database of 933 cities from 38 countries. Our results showed that (18/38) 47% of countries analyzed supported increasing density scaling (pop ~ area) with exponents ~⅚ as UST predicts. In contrast, 17 of 38 countries (~45%) exhibited density scalings statistically indistinguishable from constant population densities across cities of varying sizes. These results were generally consistent in years spanning four decades from 1975 to 2015. Importantly, density varies by an order of magnitude between regions and countries and decreases in more developed economies. Our results (i) point to how economic and regional differences may affect the scaling of density with city size and (ii) show how understanding country- and region-specific strategies could inform effective management of urban systems for biodiversity, public health, conservation and resiliency from local to global scales.200 word statement of contribution: Urban Scaling Theory (UST) is a general scaling framework that makes quantitative predictions for how many urban attributes spanning physical, biological and social dimensions scale with city size; thus, UST has great implications in guiding future city developments. A major assumption of UST is that larger cities become denser. We evaluated this assumption using a publicly available global dataset of 933 cities in 38 countries. Our scaling analysis of population size and area of cities revealed that while many countries analyzed showed increasing densities with city size, about 45% of countries showed constant densities across cities. These results question a key assumption of UST. Our results suggest policies and management strategies for biodiversity conservation, public health and sustainability of urban systems may need to be tailored to national and regional scaling relations to be effective.
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10
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Colombo PM, Freylersythe S, Sprinkle MM, Ernst KC, Yubeta M, Barbati JL, Merchant N, Iyengar S, Crane TE, Oxnam M, Rains SA. Design and implementation of a health messaging protocol employed for use within a COVID-19 health dissemination platform. Front Public Health 2022; 10:942795. [PMID: 36504998 PMCID: PMC9731134 DOI: 10.3389/fpubh.2022.942795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 10/31/2022] [Indexed: 11/25/2022] Open
Abstract
Introduction AZCOVIDTXT, a bilingual, two-way information sharing platform was created in April of 2020 in response to rising COVID-19 cases in Arizona. The aim of this paper is to delineate the protocol and processes used to develop and disseminate health messaging to serve as guidance for other groups, universities, or public health programs in the implementation or enhancement of health communication services. Methods Health messaging formats included website articles, published on the system's website (azcovidtxt.org), infographics posted on social media, and SMS. Social media and SMS infographics were intended to highlight and augment the topics covered in the weekly website articles, to create a seamless multimodal source of reliable COVID-19 information for AZCOVIDTXT enrollees and the broader public. All health messaging information, text message and social media content was planned and reviewed collaboratively by the AZCOVIDTXT team topic experts for accuracy, efficacy, and content consistency. Results As of July 2021, AZCOVIDTXT provided weekly COVID-19-related health communication to 3,747 participating households located across 225 Arizona zip codes. AZCOVIDTXT has developed and sent 446 unique, bilingual SMS for a total of 271,977 contact points. The team has produced and published 179 website articles, which averaged a combined 7,000-page views per month, and 173 social media posts were made available to 268 followers across three platforms. Discussion Several programmatic aspects were deemed essential to the success of AZCOVIDTXT. These included (1) addressing community specific needs, (2) creating timely and relevant content, (3) developing an adaptable system, and (4) prioritizing system automation where possible, (5) having an interdisciplinary team approach to identifying and crafting key messages.
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Affiliation(s)
- Paulina M. Colombo
- Department of Epidemiology and Biostatistics, College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Sarah Freylersythe
- The University of Arizona Cancer Center, Tucson, AZ, United States,Department of Internal Medicine, University of Arizona College of Medicine, Phoenix, AZ, United States
| | | | - Kacey C. Ernst
- Department of Epidemiology and Biostatistics, College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Marcela Yubeta
- Department of Epidemiology and Biostatistics, College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Juliana L. Barbati
- Department of Communication, The University of Arizona, Tucson, AZ, United States
| | - Nirav Merchant
- Data Science Institute, The University of Arizona, Tucson, AZ, United States
| | - Sriram Iyengar
- Department of Internal Medicine, University of Arizona College of Medicine, Phoenix, AZ, United States,BIO5 Institute, The University of Arizona, Tucson, AZ, United States
| | - Tracy E. Crane
- The University of Arizona Cancer Center, Tucson, AZ, United States,Department of Internal Medicine, University of Arizona College of Medicine, Phoenix, AZ, United States
| | - Maliaca Oxnam
- Data Science Institute, The University of Arizona, Tucson, AZ, United States
| | - Stephen A. Rains
- Department of Communication, The University of Arizona, Tucson, AZ, United States,*Correspondence: Stephen A. Rains
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11
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Joshi N, Lopus S, Hannah C, Ernst KC, Kilungo AP, Opiyo R, Ngayu M, Davies J, Evans T. COVID-19 lockdowns: Employment and business disruptions, water access and hygiene practices in Nairobi's informal settlements. Soc Sci Med 2022; 308:115191. [PMID: 35930847 PMCID: PMC9258418 DOI: 10.1016/j.socscimed.2022.115191] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 04/25/2022] [Accepted: 06/30/2022] [Indexed: 12/05/2022]
Abstract
Host to one billion people around the world, informal settlements are especially vulnerable to COVID-19 lockdown measures as they already lack basic services such as water, toilets, and secure housing. Additionally, many residents work in informal labor markets that have been affected by the lockdowns, resulting in further reductions in access to resources, including clean water. This study uses a cross-sectional design (n = 532) to examine the vulnerabilities of households to employment and business disruptions, water access and hygiene practices during the COVID-19 lockdowns between April and June 2020 in three informal settlements in Nairobi, Kenya. We used survey questions from the Household Water Insecurity Experience Scale (HWISE) to investigate the relationship between employment and business disruptions, water access, and hygiene practices (i.e., hand washing, body washing, clothes washing, and being able to use or drink clean water). Of the sampled households, 96% were forced to reduce work hours during the lockdowns, and these households had 92% lower odds of being able to afford water than households who did not experience a work hour reduction (OR = 0.08, p < .001). Household challenges in affording water were likely due to a combination of reduced household income, increased water prices, and pre-existing poverty, and were ultimately associated with lower hygiene scores (Beta = 1.9, p < .001). Our results highlight a compounding tragedy of reduced water access in informal settlements that were already facing water insecurities at a time when water is a fundamental requirement for following hygiene guidelines to reduce disease burden during an ongoing pandemic. These outcomes emphasize the need for targeted investments in permanent water supply infrastructures and improved hygiene behaviors as a public health priority among households in informal settlements.
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Affiliation(s)
- Nupur Joshi
- School of Geography, Development and Environment, University of Arizona, United States.
| | - Sara Lopus
- Department of Social Sciences, California Polytechnic State University - San Luis Obispo, United States.
| | - Corrie Hannah
- Arizona Institutes for Resilient Environment and Societies (AIRES), University of Arizona, United States.
| | - Kacey C Ernst
- Epidemiology and Biostatistics Department, University of Arizona, United States.
| | - Aminata P Kilungo
- Community, Environment, and Policy Department, University of Arizona, United States.
| | - Romanus Opiyo
- Department of Urban and Regional Planning, University of Nairobi, Kenya.
| | - Margaret Ngayu
- Department of Urban and Regional Planning, University of Nairobi, Kenya.
| | - Julia Davies
- School of Geography, Development and Environment, University of Arizona, United States.
| | - Tom Evans
- School of Geography, Development and Environment, University of Arizona, United States.
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12
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Fernandez MP, Ernst KC, Bron GM, Berry K, Diuk-Wasser MA, Hayden MH. Outdoor Activity Associated with Higher Self-Reported Emotional Well-Being During COVID-19. Ecohealth 2022; 19:154-158. [PMID: 35687197 PMCID: PMC9186007 DOI: 10.1007/s10393-022-01598-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Accepted: 03/18/2022] [Indexed: 06/15/2023]
Abstract
Shifts in activity patterns during the COVID-19 pandemic might have impacted the benefits of outdoor activities for mental health. By leveraging an existing mobile application, we collected self-reported data on daily outdoor activities, emotional well-being, and the influence of COVID-19 on participant's outdoor activity levels during April-July 2020. Individuals reporting outdoor activities, in greenspaces or in their residence, had higher well-being scores and this effect increased with age. Self-reported impacts of COVID-19 on emotional well-being were associated with lower well-being scores. This work suggests that outdoor activities may have improved mental health during the COVID-19 pandemic.
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Affiliation(s)
- M Pilar Fernandez
- Earth Institute, Columbia University, New York, NY, USA
- Department of Ecology, Evolution and Environmental Biology, Columbia University, New York, NY, USA
- Paul G. Allen School for Global Health, Washington State University, Pullman, WA, USA
| | - Kacey C Ernst
- Department of Epidemiology and Biostatistics, University of Arizona, Arizona, AZ, USA
| | - Gebbiena M Bron
- Department of Entomology, University of Wisconsin-Madison, Madison, WI, USA
| | - Kevin Berry
- College of Business and Public Policy, University of Alaska Anchorage, Anchorage, AK, USA
| | - Maria A Diuk-Wasser
- Department of Ecology, Evolution and Environmental Biology, Columbia University, New York, NY, USA
| | - Mary H Hayden
- Lyda Hill Institute for Human Resilience at UCCS, 4863 North Nevada Avenue, Fourth floor, Colorado Springs, CO, 80918, USA.
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13
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Habila MA, Valencia DY, Khan SM, Heslin KM, Hoskinson J, Ernst KC, Pogreba-Brown K, Jacobs ET, Cordova-Marks FM, Warholak T. A Rasch analysis assessing the reliability and validity of the Arizona CoVHORT COVID-19 vaccine questionnaire. SSM Popul Health 2022; 17:101040. [PMID: 35155727 PMCID: PMC8824717 DOI: 10.1016/j.ssmph.2022.101040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 02/01/2022] [Accepted: 02/02/2022] [Indexed: 11/30/2022] Open
Abstract
Background Despite the widespread availability of COVID-19 vaccines in the United States, many that have chosen not to be vaccinated have done so because of vaccine hesitancy. This highlights the need for tools that accurately capture the knowledge, attitudes, and beliefs towards COVID-19 vaccines, and provide steps toward improving vaccine acceptance. Methods Participants of the Arizona CoVHORT (COVID-19 Cohort) received a one-time, electronic based cross-sectional questionnaire intended to capture underlying motivations regarding vaccination, as well as hesitations that may prevent people from getting vaccinated. Rasch analysis was conducted among 4703 CoVHORT participants who had completed the vaccine questionnaire to assess questionnaire reliability and validity. Response categories were grouped to optimize scale functioning and to ensure independent probabilities of participant endorsement. Results A total of 4703 CoVHORT participants completed the questionnaire, of whom 68% were female, and who had a mean age of 48 years. Participants were primarily White (90%), highly educated (63% with a college degree or above, with most respondents (45%) having an income of more than $75,000 per annum. The results indicated the questionnaire has good reliability and construct validity for assessing attitudes and beliefs about the COVID-19 vaccines. In-fit mean-squares for included items ranged from 0.61 to 1.72 and outfit mean-squares ranged from 0.56 to 1.75, and correlation coefficients ranged from 0.25 to 0.75. The person-item map indicated normal distribution of logit scores measuring perceptions about COVID-19 vaccinations. Conclusions The CoVHORT vaccine questionnaire demonstrated satisfactory reliability and construct validity in assessing attitudes and beliefs about COVID-19 vaccines. Overall results provide a starting point for a reliable and valid tool to assess knowledge and perceptions about COVID-19 vaccination, ultimately providing public health professionals with an instrument to assess the factors that are associated with vaccine acceptance or hesitancy.
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Affiliation(s)
- Magdiel A Habila
- University of Arizona, Department of Epidemiology and Biostatistics, Tucson, AZ, USA.,University of Arizona, College of Pharmacy, Department of Health and Pharmaceutical Outcomes, Tucson, AZ, USA
| | - Dora Y Valencia
- University of Arizona, College of Medicine, Department of Clinical and Translational Sciences, Tucson, AZ, USA
| | - Sana M Khan
- University of Arizona, Department of Epidemiology and Biostatistics, Tucson, AZ, USA
| | - Kelly M Heslin
- University of Arizona, Department of Epidemiology and Biostatistics, Tucson, AZ, USA
| | | | - Kacey C Ernst
- University of Arizona, Department of Epidemiology and Biostatistics, Tucson, AZ, USA
| | - Kristen Pogreba-Brown
- University of Arizona, Department of Epidemiology and Biostatistics, Tucson, AZ, USA
| | - Elizabeth T Jacobs
- University of Arizona, Department of Epidemiology and Biostatistics, Tucson, AZ, USA
| | - Felina M Cordova-Marks
- University of Arizona, Department of Health Behavior and Health Promotion, Tucson, AZ, USA
| | - Terri Warholak
- University of Arizona, College of Pharmacy, Department of Health and Pharmaceutical Outcomes, Tucson, AZ, USA
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14
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Donzella SM, Kohler LN, Crane TE, Jacobs ET, Ernst KC, Bell ML, Catalfamo CJ, Begay R, Pogreba-Brown K, Farland LV. COVID-19 Infection, the COVID-19 Pandemic, and Changes in Sleep. Front Public Health 2022; 9:795320. [PMID: 35174134 PMCID: PMC8841649 DOI: 10.3389/fpubh.2021.795320] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 12/10/2021] [Indexed: 01/07/2023] Open
Abstract
The objective of this study was to investigate the differences in sleep patterns among individuals with and without laboratory-confirmed SARS-CoV-2 infection. Laboratory-confirmed SARS-CoV-2 test results and self-reported measures recalling sleep habits prior to and during the pandemic were collected from May 2020 to March 2021 among 1,848 individuals in The Arizona CoVHORT Study. We used linear and logistic regression to model the association between test status, presentation of symptoms, and time since test result with sleep duration and trouble sleeping, respectively. Mixed models were used to investigate change in sleep duration prior to the pandemic compared to during the pandemic. Overall, 16.2% of the sample were SARS-CoV-2 positive, 64.3% were SARS-CoV-2 negative, and 19.5% were untested for SARS-CoV-2. Independent of SARS-CoV-2 infection status, all participants slept longer during the pandemic compared to pre-pandemic (Δ SARS-CoV-2 positive: 77.7 min, 95% CI 67.9, 87.5; Δ SARS-CoV-2 negative: 13.4 min, 95% CI 8.4, 18.3). However, SARS-CoV-2 positive participants slept 60.9 min longer (95% CI 49.1, 72.8) than SARS-CoV-2 negative participants in multivariable-adjusted models and had greater odds of trouble sleeping three or more times per week since the start of the pandemic (OR: 1.34 95% CI 1.02, 1.77) This greater odds of trouble sleeping persisted for participants who reported sleep habits > 30 days after their positive SARS-CoV-2 (OR: 2.11 95% CI 1.47, 3.03). Sleep patterns among non-hospitalized individuals with COVID-19 were altered following infection, regardless of the presentation of symptoms and time since infection.
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Affiliation(s)
- Sidney M. Donzella
- Department of Epidemiology and Biostatistics, University of Arizona, Tucson, AZ, United States
- Department of Epidemiology, University of Washington, Seattle, WA, United States
| | - Lindsay N. Kohler
- Department of Epidemiology and Biostatistics, University of Arizona, Tucson, AZ, United States
- University of Arizona Cancer Center, Tucson, AZ, United States
- Department of Health Promotion Science, University of Arizona, Tucson, AZ, United States
| | - Tracy E. Crane
- Department of Medical Oncology, University of Miami, Miami, FL, United States
| | - Elizabeth T. Jacobs
- Department of Epidemiology and Biostatistics, University of Arizona, Tucson, AZ, United States
- University of Arizona Cancer Center, Tucson, AZ, United States
| | - Kacey C. Ernst
- Department of Epidemiology and Biostatistics, University of Arizona, Tucson, AZ, United States
| | - Melanie L. Bell
- Department of Epidemiology and Biostatistics, University of Arizona, Tucson, AZ, United States
| | - Collin J. Catalfamo
- Department of Epidemiology and Biostatistics, University of Arizona, Tucson, AZ, United States
| | - Rachelle Begay
- Department of Epidemiology and Biostatistics, University of Arizona, Tucson, AZ, United States
| | - Kristen Pogreba-Brown
- Department of Epidemiology and Biostatistics, University of Arizona, Tucson, AZ, United States
| | - Leslie V. Farland
- Department of Epidemiology and Biostatistics, University of Arizona, Tucson, AZ, United States
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15
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Khan SM, Farland LV, Catalfamo CJ, Austhof E, Bell ML, Chen Z, Cordova-Marks F, Ernst KC, Garcia-Filion P, Heslin KM, Hoskinson J, Jehn ML, Joseph ECS, Kelley CP, Klimentidis Y, Russo Carroll S, Kohler LN, Pogreba-Brown K, Jacobs ET. Elucidating symptoms of COVID-19 illness in the Arizona CoVHORT: a longitudinal cohort study. BMJ Open 2022; 12:e053403. [PMID: 35039294 PMCID: PMC8764711 DOI: 10.1136/bmjopen-2021-053403] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE To elucidate the symptoms of laboratory-confirmed COVID-19 cases as compared with laboratory-confirmed negative individuals and to the untested general population among all participants who reported symptoms within a large prospective cohort study. SETTING AND DESIGN This work was conducted within the framework of the Arizona CoVHORT, a longitudinal prospective cohort study conducted among Arizona residents. PARTICIPANTS Eligible participants were any individual living in Arizona and were recruited from across Arizona via COVID-19 case investigations, participation in testing studies and a postcard mailing effort. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome measure was a comparison of the type and frequency of symptoms between COVID-19-positive cases, tested but negative individuals and the general untested population who reported experiencing symptoms consistent with COVID-19. RESULTS Of the 1335 laboratory-confirmed COVID-19 cases, 180 (13.5%) reported having no symptoms. Of those that did report symptoms, the most commonly reported were fatigue (82.2%), headache (74.6%), aches, pains or sore muscles (66.3%), loss of taste or smell (62.8) and cough (61.9%). In adjusted logistic regression models, COVID-19-positive participants were more likely than negative participants to experience loss of taste and smell (OR 12.1; 95% CI 9.6 to 15.2), bone or nerve pain (OR 3.0; 95% CI 2.2 to 4.1), headache (OR 2.6; 95% CI 2.2 to 3.2), nausea (OR 2.4; 95% CI 1.9 to 3.1) or diarrhoea (OR 2.1; 95% CI 1.7 to 2.6). Fatigue (82.9) and headache (74.9) had the highest sensitivities among symptoms, while loss of taste or smell (87.2) and bone or nerve pain (92.9) had the high specificities among significant symptoms associated with COVID-19. CONCLUSION When comparing confirmed COVID-19 cases with either confirmed negative or untested participants, the pattern of symptoms that discriminates SARS-CoV-2 infection from those arising from other potential circulating pathogens may differ from general reports of symptoms among cases alone.
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Affiliation(s)
- Sana M Khan
- Department of Epidemiology and Biostatistics, The University of Arizona, Tucson, Arizona, USA
| | - Leslie V Farland
- Department of Epidemiology and Biostatistics, The University of Arizona, Tucson, Arizona, USA
- The University of Arizona Cancer Center, Tucson, Arizona, USA
| | - Collin J Catalfamo
- Department of Epidemiology and Biostatistics, The University of Arizona, Tucson, Arizona, USA
| | - Erika Austhof
- Department of Epidemiology and Biostatistics, The University of Arizona, Tucson, Arizona, USA
| | - Melanie L Bell
- Department of Epidemiology and Biostatistics, The University of Arizona, Tucson, Arizona, USA
- The University of Arizona Cancer Center, Tucson, Arizona, USA
| | - Zhao Chen
- Department of Epidemiology and Biostatistics, The University of Arizona, Tucson, Arizona, USA
| | - Felina Cordova-Marks
- The University of Arizona Cancer Center, Tucson, Arizona, USA
- Department of Health Promotion Sciences, The University of Arizona, Tucson, Arizona, USA
| | - Kacey C Ernst
- Department of Epidemiology and Biostatistics, The University of Arizona, Tucson, Arizona, USA
| | - Pamela Garcia-Filion
- Department of Biomedical Informatics, The University of Arizona, Tucson, Arizona, USA
| | - Kelly M Heslin
- Department of Epidemiology and Biostatistics, The University of Arizona, Tucson, Arizona, USA
| | | | - Megan L Jehn
- School of Human Evolution and Social Change, Arizona State University, Tempe, Arizona, USA
| | | | - Connor P Kelley
- Department of Epidemiology and Biostatistics, The University of Arizona, Tucson, Arizona, USA
| | - Yann Klimentidis
- Department of Epidemiology and Biostatistics, The University of Arizona, Tucson, Arizona, USA
| | - Stephanie Russo Carroll
- Department of Community, Environment, and Policy, The University of Arizona, Tucson, Arizona, USA
- Native Nations Institute at the Udall Center for Studies in Public Policy, The University of Arizona, Tucson, Arizona, USA
| | - Lindsay N Kohler
- Department of Epidemiology and Biostatistics, The University of Arizona, Tucson, Arizona, USA
- The University of Arizona Cancer Center, Tucson, Arizona, USA
- Department of Health Promotion Sciences, The University of Arizona, Tucson, Arizona, USA
| | - Kristen Pogreba-Brown
- Department of Epidemiology and Biostatistics, The University of Arizona, Tucson, Arizona, USA
| | - Elizabeth T Jacobs
- Department of Epidemiology and Biostatistics, The University of Arizona, Tucson, Arizona, USA
- The University of Arizona Cancer Center, Tucson, Arizona, USA
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16
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Bandzuh JT, Ernst KC, Gunn JKL, Pandarangga S, Yowi LRK, Hobgen S, Cavanaugh KR, Kalaway RY, Kalunga NRJ, Killa MF, Ara UH, Uejio CK, Hayden MH. Knowledge, attitudes, and practices of Anopheles mosquito control through insecticide treated nets and community-based health programs to prevent malaria in East Sumba Island, Indonesia. PLOS Glob Public Health 2022; 2:e0000241. [PMID: 36962713 PMCID: PMC10021134 DOI: 10.1371/journal.pgph.0000241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 07/19/2022] [Indexed: 11/19/2022]
Abstract
With an estimated 241 million human cases and 627,000 deaths in 2020, malaria remains a significant and ongoing global health challenge. This study employs a qualitative approach to investigate knowledge, attitudes, and practices surrounding mosquito control and prevention methods in East Sumba Regency, Indonesia. While malaria is under control in much of Indonesia, transmission in Sumba Island remains high, with incidence as high as 500 per 1000 population in some areas. A qualitative study was undertaken to explore use of insecticide treated nets, (ITNs), traditional Sumbanese mosquito control methods, and the role of women, integrated health service posts, (posyandu) and community-based health workers (kaders) in combatting malaria and controlling mosquitoes. Focus group discussions (n = 7) were conducted in East Sumba Island stratified by urban/rural location and level of malaria transmission. Key informant interviews (n = 14) were conducted with religious leaders, health workers, and women's group leaders. Results indicate that environmental conditions, such as high temperatures, were common deterrents to regular ITN use. Furthermore, our results suggest that community embedded health workers, kaders, and health service posts, posyandu, play an important role in information dissemination related to mosquitoes and mosquito-borne diseases as well as the distribution and use of ITNs in East Sumba Island. The role of the posyandu and kaders could be expanded to improve malaria prevention by integration with educational campaigns, aiding ITN distributions, and malaria diagnosis and treatment. This study is the first to examine mosquito-borne disease-related knowledge, attitudes, and practices in East Sumba Island, Indonesia. Results could improve mosquito control and malaria prevention by providing insights into local knowledge of Anopheles mosquitoes and malaria as well. Tailoring mosquito control and malaria prevention strategies around local knowledge and perceptions is likely to be more acceptable and sustainable.
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Affiliation(s)
- John T Bandzuh
- Department of Geography, College of Social Science and Public Policy, Florida State University, Tallahassee, FL, United States of America
| | - Kacey C Ernst
- Department of Epidemiology and Biostatistics, College of Public Health, University of Arizona, Tucson, AZ, United States of America
| | - Jayleen K L Gunn
- Department of Epidemiology and Biostatistics, College of Public Health, University of Arizona, Tucson, AZ, United States of America
| | | | | | | | - Kerry R Cavanaugh
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | | | | | - Umbu Ho Ara
- Universitas Kristen Wira Wacana Sumba, East Sumba Island, Indonesia
| | - Christopher K Uejio
- Department of Geography, College of Social Science and Public Policy, Florida State University, Tallahassee, FL, United States of America
| | - Mary H Hayden
- University of Colorado, Lyda Hill Institute for Human Resilience, Colorado Springs, CO, United States of America
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17
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Wilson AM, Aviles N, Petrie JI, Beamer PI, Szabo Z, Xie M, McIllece J, Chen Y, Son Y, Halai S, White T, Ernst KC, Masel J. Quantifying SARS-CoV-2 Infection Risk Within the Google/Apple Exposure Notification Framework to Inform Quarantine Recommendations. Risk Anal 2022; 42:162-176. [PMID: 34155669 PMCID: PMC8447042 DOI: 10.1111/risa.13768] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 01/31/2021] [Accepted: 05/24/2021] [Indexed: 05/13/2023]
Abstract
Most early Bluetooth-based exposure notification apps use three binary classifications to recommend quarantine following SARS-CoV-2 exposure: a window of infectiousness in the transmitter, ≥15 minutes duration, and Bluetooth attenuation below a threshold. However, Bluetooth attenuation is not a reliable measure of distance, and infection risk is not a binary function of distance, nor duration, nor timing. We model uncertainty in the shape and orientation of an exhaled virus-containing plume and in inhalation parameters, and measure uncertainty in distance as a function of Bluetooth attenuation. We calculate expected dose by combining this with estimated infectiousness based on timing relative to symptom onset. We calibrate an exponential dose-response curve based on infection probabilities of household contacts. The probability of current or future infectiousness, conditioned on how long postexposure an exposed individual has been symptom-free, decreases during quarantine, with shape determined by incubation periods, proportion of asymptomatic cases, and asymptomatic shedding durations. It can be adjusted for negative test results using Bayes' theorem. We capture a 10-fold range of risk using six infectiousness values, 11-fold range using three Bluetooth attenuation bins, ∼sixfold range from exposure duration given the 30 minute duration cap imposed by the Google/Apple v1.1, and ∼11-fold between the beginning and end of 14 day quarantine. Public health authorities can either set a threshold on initial infection risk to determine 14-day quarantine onset, or on the conditional probability of current and future infectiousness conditions to determine both quarantine and duration.
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Affiliation(s)
- Amanda M. Wilson
- Mel & Enid Zuckerman College of Public HealthUniversity of Arizona1295 N Martin AveTucsonAZ85724USA
- Rocky Mountain Center for Occupational and Environmental HealthUniversity of Utah391 Chipeta Way suite cSalt Lake CityUT84108USA
| | - Nathan Aviles
- Graduate Interdisciplinary Program in StatisticsUniversity of Arizona617 N. Santa Rita Ave.TucsonAZ85721USA
| | - James I. Petrie
- WeHealth Solutions PBC5325 Elkhorn Blvd # 7011SacramentoCA95842USA
- Applied MathematicsUniversity of Waterloo200 University Ave. WWaterlooOntarioN2L 3G1Canada
- Covid Watch (affiliation at time of writing, now dissolved)
| | - Paloma I. Beamer
- Mel & Enid Zuckerman College of Public HealthUniversity of Arizona1295 N Martin AveTucsonAZ85724USA
| | - Zsombor Szabo
- Covid Watch (affiliation at time of writing, now dissolved)
| | - Michelle Xie
- WeHealth Solutions PBC5325 Elkhorn Blvd # 7011SacramentoCA95842USA
- Covid Watch (affiliation at time of writing, now dissolved)
| | - Janet McIllece
- World Wide Technology1 World Wide WaySt. LouisMO63146USA
| | - Yijie Chen
- Systems and Industrial EngineeringUniversity of Arizona1127 E. James E. Rogers WayTucsonAZ85721USA
| | - Young‐Jun Son
- Systems and Industrial EngineeringUniversity of Arizona1127 E. James E. Rogers WayTucsonAZ85721USA
| | - Sameer Halai
- WeHealth Solutions PBC5325 Elkhorn Blvd # 7011SacramentoCA95842USA
- Covid Watch (affiliation at time of writing, now dissolved)
| | - Tina White
- Covid Watch (affiliation at time of writing, now dissolved)
| | - Kacey C. Ernst
- Mel & Enid Zuckerman College of Public HealthUniversity of Arizona1295 N Martin AveTucsonAZ85724USA
| | - Joanna Masel
- WeHealth Solutions PBC5325 Elkhorn Blvd # 7011SacramentoCA95842USA
- Ecology & Evolutionary BiologyUniversity of Arizona1041 E Lowell StTucsonAZ85721USA
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Coalson JE, Anderson EJ, Santos EM, Madera Garcia V, Romine JK, Luzingu JK, Dominguez B, Richard DM, Little AC, Hayden MH, Ernst KC. Erratum: "The Complex Epidemiologic Relationship between Flooding Events and Human Outbreaks of Mosquito-Borne Diseases: A Scoping Review". Environ Health Perspect 2021; 129:129001. [PMID: 34962828 PMCID: PMC8713774 DOI: 10.1289/ehp10706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 12/03/2021] [Indexed: 06/14/2023]
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19
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Huete-Pérez JA, Ernst KC, Cabezas-Robelo C, Páiz-Medina L, Silva S, Huete A. Prevalence and risk factors for SARS-CoV-2 infection in children with and without symptoms seeking care in Managua, Nicaragua: results of a cross-sectional survey. BMJ Open 2021; 11:e051836. [PMID: 34548362 PMCID: PMC8457995 DOI: 10.1136/bmjopen-2021-051836] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE This study aimed to capture key epidemiological data on SARS-CoV-2 infection in Nicaraguan children (≤18 years) seeking medical care, between 6 October and 16 November 2020. DESIGN In this cross-sectional study, 418 children were recruited: 319 with symptoms characteristic of COVID-19 and 99 with no symptoms of illness. Children were tested for SARS-CoV-2 RNA using loop-mediated isothermal amplification. A questionnaire was employed to identify symptoms, risk factors, comorbidities and COVID-19 prevention measures. SETTING Research was carried out in four hospitals and two clinics in Managua, Nicaragua, where schools and businesses remained open throughout the COVID-19 pandemic. PARTICIPANTS Children were enrolled into a possible COVID-19 group if presenting with clinical symptoms. A comparison group included children lacking any COVID-19 symptoms attending routine check-ups or seeking care for issues unrelated to COVID-19. RESULTS A high prevalence (43%) of SARS-CoV-2 infection was found, which was relatively equivalent in symptomatic and non-symptomatic children. Age distribution was similar between symptomatic and non-symptomatic children testing positive for SARS-CoV-2. Symptomatic children who tested positive for SARS-CoV-2 were 2.7 times more likely to have diarrhoea (26.7% in positive vs 12.0% in negative; OR=2.7 (95% CI 1.5 to 4.8), p=0.001) and were 2.0 times more likely to have myalgia (17.8% in positive vs 9.8% in negative; OR=2.0 (95% CI 1.0 to 3.8), p=0.04). Children with COVID-19 symptoms, who tested positive for SARS-CoV-2, were more likely to be under age 5 years and to have a pre-existing comorbid condition than children who tested positive but did not have symptoms. CONCLUSIONS This is the first paediatric study to provide laboratory-confirmed data on SARS-CoV-2 infection in Nicaragua, crucial for paediatric health services planning and a successful COVID-19 response. The high prevalence of the virus suggests widespread and sustained community transmission, underscoring the urgent need for robust data on the true extent of SARS-CoV-2 infection throughout Nicaragua.
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Affiliation(s)
| | - Kacey C Ernst
- Department of Epidemiology and Biostatistics, The University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, Arizona, USA
| | | | - Lucia Páiz-Medina
- Molecular Biology Center, Universidad Centroamericana, Managua, Nicaragua
| | - Sheyla Silva
- Pediatrics Unit, Vivian Pellas Hospital, Managua, Nicaragua
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20
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Coalson JE, Anderson EJ, Santos EM, Madera Garcia V, Romine JK, Luzingu JK, Dominguez B, Richard DM, Little AC, Hayden MH, Ernst KC. The Complex Epidemiological Relationship between Flooding Events and Human Outbreaks of Mosquito-Borne Diseases: A Scoping Review. Environ Health Perspect 2021; 129:96002. [PMID: 34582261 PMCID: PMC8478154 DOI: 10.1289/ehp8887] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 08/10/2021] [Accepted: 08/19/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND Climate change is expected to increase the frequency of flooding events. Although rainfall is highly correlated with mosquito-borne diseases (MBD) in humans, less research focuses on understanding the impact of flooding events on disease incidence. This lack of research presents a significant gap in climate change-driven disease forecasting. OBJECTIVES We conducted a scoping review to assess the strength of evidence regarding the potential relationship between flooding and MBD and to determine knowledge gaps. METHODS PubMed, Embase, and Web of Science were searched through 31 December 2020 and supplemented with review of citations in relevant publications. Studies on rainfall were included only if the operationalization allowed for distinction of unusually heavy rainfall events. Data were abstracted by disease (dengue, malaria, or other) and stratified by post-event timing of disease assessment. Studies that conducted statistical testing were summarized in detail. RESULTS From 3,008 initial results, we included 131 relevant studies (dengue n = 45 , malaria n = 61 , other MBD n = 49 ). Dengue studies indicated short-term (< 1 month ) decreases and subsequent (1-4 month) increases in incidence. Malaria studies indicated post-event incidence increases, but the results were mixed, and the temporal pattern was less clear. Statistical evidence was limited for other MBD, though findings suggest that human outbreaks of Murray Valley encephalitis, Ross River virus, Barmah Forest virus, Rift Valley fever, and Japanese encephalitis may follow flooding. DISCUSSION Flooding is generally associated with increased incidence of MBD, potentially following a brief decrease in incidence for some diseases. Methodological inconsistencies significantly limit direct comparison and generalizability of study results. Regions with established MBD and weather surveillance should be leveraged to conduct multisite research to a) standardize the quantification of relevant flooding, b) study nonlinear relationships between rainfall and disease, c) report outcomes at multiple lag periods, and d) investigate interacting factors that modify the likelihood and severity of outbreaks across different settings. https://doi.org/10.1289/EHP8887.
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Affiliation(s)
- Jenna E. Coalson
- Center for Insect Science, University of Arizona, Tucson, Arizona, USA
| | | | - Ellen M. Santos
- Department of Epidemiology and Biostatistics, University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, Arizona, USA
| | - Valerie Madera Garcia
- Department of Epidemiology and Biostatistics, University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, Arizona, USA
| | - James K. Romine
- Department of Epidemiology and Biostatistics, University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, Arizona, USA
| | - Joy K. Luzingu
- Department of Epidemiology and Biostatistics, University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, Arizona, USA
| | - Brian Dominguez
- Department of Epidemiology and Biostatistics, University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, Arizona, USA
| | - Danielle M. Richard
- Department of Epidemiology and Biostatistics, University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, Arizona, USA
| | - Ashley C. Little
- Department of Epidemiology and Biostatistics, University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, Arizona, USA
| | - Mary H. Hayden
- National Institute for Human Resilience, University of Colorado Colorado Springs, Colorado Springs, Colorado, USA
| | - Kacey C. Ernst
- Department of Epidemiology and Biostatistics, University of Arizona Mel and Enid Zuckerman College of Public Health, Tucson, Arizona, USA
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21
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Feng X, Merow C, Liu Z, Park DS, Roehrdanz PR, Maitner B, Newman EA, Boyle BL, Lien A, Burger JR, Pires MM, Brando PM, Bush MB, McMichael CNH, Neves DM, Nikolopoulos EI, Saleska SR, Hannah L, Breshears DD, Evans TP, Soto JR, Ernst KC, Enquist BJ. How deregulation, drought and increasing fire impact Amazonian biodiversity. Nature 2021; 597:516-521. [PMID: 34471291 DOI: 10.1038/s41586-021-03876-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 08/04/2021] [Indexed: 02/08/2023]
Abstract
Biodiversity contributes to the ecological and climatic stability of the Amazon Basin1,2, but is increasingly threatened by deforestation and fire3,4. Here we quantify these impacts over the past two decades using remote-sensing estimates of fire and deforestation and comprehensive range estimates of 11,514 plant species and 3,079 vertebrate species in the Amazon. Deforestation has led to large amounts of habitat loss, and fires further exacerbate this already substantial impact on Amazonian biodiversity. Since 2001, 103,079-189,755 km2 of Amazon rainforest has been impacted by fires, potentially impacting the ranges of 77.3-85.2% of species that are listed as threatened in this region5. The impacts of fire on the ranges of species in Amazonia could be as high as 64%, and greater impacts are typically associated with species that have restricted ranges. We find close associations between forest policy, fire-impacted forest area and their potential impacts on biodiversity. In Brazil, forest policies that were initiated in the mid-2000s corresponded to reduced rates of burning. However, relaxed enforcement of these policies in 2019 has seemingly begun to reverse this trend: approximately 4,253-10,343 km2 of forest has been impacted by fire, leading to some of the most severe potential impacts on biodiversity since 2009. These results highlight the critical role of policy enforcement in the preservation of biodiversity in the Amazon.
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Affiliation(s)
- Xiao Feng
- Department of Geography, Florida State University, Tallahassee, FL, USA.
| | - Cory Merow
- Eversource Energy Center and Department of Ecology and Evolutionary Biology, University of Connecticut, Storrs, CT, USA
| | - Zhihua Liu
- CAS Key Laboratory of Forest Ecology and Management, Institute of Applied Ecology, Chinese Academy of Sciences, Shenyang, China
| | - Daniel S Park
- Department of Biological Sciences, Purdue University, West Lafayette, IN, USA.,Purdue Center for Plant Biology, Purdue University, West Lafayette, IN, USA
| | - Patrick R Roehrdanz
- The Moore Center for Science, Conservation International, Arlington, VA, USA
| | - Brian Maitner
- Eversource Energy Center and Department of Ecology and Evolutionary Biology, University of Connecticut, Storrs, CT, USA
| | - Erica A Newman
- Department of Ecology and Evolutionary Biology, University of Arizona, Tucson, AZ, USA.,Arizona Institutes for Resilience, University of Arizona, Tucson, AZ, USA
| | - Brad L Boyle
- Department of Ecology and Evolutionary Biology, University of Arizona, Tucson, AZ, USA.,Hardner & Gullison Associates, Amherst, NH, USA
| | - Aaron Lien
- Arizona Institutes for Resilience, University of Arizona, Tucson, AZ, USA.,School of Natural Resources and the Environment, University of Arizona, Tucson, AZ, USA
| | - Joseph R Burger
- Department of Ecology and Evolutionary Biology, University of Arizona, Tucson, AZ, USA.,Arizona Institutes for Resilience, University of Arizona, Tucson, AZ, USA.,Department of Biology, University of Kentucky, Lexington, KY, USA
| | - Mathias M Pires
- Departamento de Biologia Animal, Universidade Estadual de Campinas, Campinas, Brazil
| | - Paulo M Brando
- Department of Earth System Science, University of California, Irvine, Irvine, CA, USA.,Woodwell Climate Research Center, Falmouth, MA, USA.,Instituto de Pesquisa Ambiental da Amazônia (IPAM), Brasilia, Brazil
| | - Mark B Bush
- Insitute for Global Ecology, Florida Institute of Technology, Melbourne, FL, USA
| | - Crystal N H McMichael
- Department of Ecosystem and Landscape Dynamics, Institute for Biodiversity and Ecosystem Dynamics, University of Amsterdam, Amsterdam, The Netherlands
| | - Danilo M Neves
- Institute of Biological Sciences, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Efthymios I Nikolopoulos
- Department of Mechanical and Civil Engineering, Florida Institute of Technology, Melbourne, FL, USA
| | - Scott R Saleska
- Department of Ecology and Evolutionary Biology, University of Arizona, Tucson, AZ, USA
| | - Lee Hannah
- The Moore Center for Science, Conservation International, Arlington, VA, USA
| | - David D Breshears
- School of Natural Resources and the Environment, University of Arizona, Tucson, AZ, USA
| | - Tom P Evans
- School of Geography, Development and Environment, University of Arizona, Tucson, AZ, USA
| | - José R Soto
- School of Natural Resources and the Environment, University of Arizona, Tucson, AZ, USA
| | - Kacey C Ernst
- Department of Epidemiology and Biostatistics, College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Brian J Enquist
- Department of Ecology and Evolutionary Biology, University of Arizona, Tucson, AZ, USA.,The Santa Fe Institute, Santa Fe, NM, USA
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22
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Bell ML, Catalfamo CJ, Farland LV, Ernst KC, Jacobs ET, Klimentidis YC, Jehn M, Pogreba-Brown K. Post-acute sequelae of COVID-19 in a non-hospitalized cohort: Results from the Arizona CoVHORT. PLoS One 2021; 16:e0254347. [PMID: 34347785 PMCID: PMC8336814 DOI: 10.1371/journal.pone.0254347] [Citation(s) in RCA: 83] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2021] [Accepted: 06/25/2021] [Indexed: 11/25/2022] Open
Abstract
Clinical presentation, outcomes, and duration of COVID-19 has ranged dramatically. While some individuals recover quickly, others suffer from persistent symptoms, collectively known as long COVID, or post-acute sequelae of SARS-CoV-2 (PASC). Most PASC research has focused on hospitalized COVID-19 patients with moderate to severe disease. We used data from a diverse population-based cohort of Arizonans to estimate prevalence of PASC, defined as experiencing at least one symptom 30 days or longer, and prevalence of individual symptoms. There were 303 non-hospitalized individuals with a positive lab-confirmed COVID-19 test who were followed for a median of 61 days (range 30-250). COVID-19 positive participants were mostly female (70%), non-Hispanic white (68%), and on average 44 years old. Prevalence of PASC at 30 days post-infection was 68.7% (95% confidence interval: 63.4, 73.9). The most common symptoms were fatigue (37.5%), shortness-of-breath (37.5%), brain fog (30.8%), and stress/anxiety (30.8%). The median number of symptoms was 3 (range 1-20). Amongst 157 participants with longer follow-up (≥60 days), PASC prevalence was 77.1%.
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Affiliation(s)
- Melanie L. Bell
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ, United States of America
| | - Collin J. Catalfamo
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ, United States of America
| | - Leslie V. Farland
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ, United States of America
| | - Kacey C. Ernst
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ, United States of America
| | - Elizabeth T. Jacobs
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ, United States of America
| | - Yann C. Klimentidis
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ, United States of America
| | - Megan Jehn
- School of Human Evolution and Social Change, Arizona State University, Tempe, AZ, United States of America
| | - Kristen Pogreba-Brown
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ, United States of America
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23
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Catalfamo CJ, Heslin KM, Shilen A, Khan SM, Hunsaker JR, Austhof E, Barraza L, Cordova-Marks FM, Farland LV, Garcia-Filion P, Hoskinson J, Jehn M, Kohler LN, Lutrick K, Harris RB, Chen Z, Klimentidis YC, Bell ML, Ernst KC, Jacobs ET, Pogreba-Brown K. Design of the Arizona CoVHORT: A Population-Based COVID-19 Cohort. Front Public Health 2021; 9:620060. [PMID: 33643990 PMCID: PMC7902773 DOI: 10.3389/fpubh.2021.620060] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Accepted: 01/07/2021] [Indexed: 01/14/2023] Open
Abstract
This study is a prospective, population-based cohort of individuals with a history of SARS-CoV-2 infection and those without past infection through multiple recruitment sources. The main study goal is to track health status over time, within the diverse populations of Arizona and to identify the long-term consequences of COVID-19 on health and well-being. A total of 2,881 study participants (16.2% with a confirmed SARS-CoV-2 infection) have been enrolled as of December 22, 2020, with a target enrollment of 10,000 participants and a planned follow-up of at least 2 years. This manuscript describes a scalable study design that utilizes a wide range of recruitment sources, leveraging electronic data collection to capture and link longitudinal participant data on the current and emerging issues associated with the COVID-19 pandemic. The cohort is built within a collaborative infrastructure that includes new and established partnerships with multiple stakeholders, including the state's public universities, local health departments, tribes, and tribal organizations. Challenges remain for ensuring recruitment of diverse participants and participant retention, although the electronic data management system and timing of participant contact can help to mitigate these problems.
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Affiliation(s)
- Collin J Catalfamo
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ, United States
| | - Kelly M Heslin
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ, United States
| | - Alexandra Shilen
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ, United States
| | - Sana M Khan
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ, United States
| | - Josh R Hunsaker
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ, United States
| | - Erika Austhof
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ, United States
| | - Leila Barraza
- Department of Community, Environment and Policy, Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ, United States
| | | | - Leslie V Farland
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ, United States
| | - Pamela Garcia-Filion
- Department of Biomedical Informatics, College of Medicine-Phoenix, The University of Arizona, Phoenix, AZ, United States
| | - Joshua Hoskinson
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ, United States
| | - Megan Jehn
- School of Human Evolution and Social Change, Arizona State University, Tempe, AZ, United States
| | - Lindsay N Kohler
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ, United States.,Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ, United States
| | - Karen Lutrick
- Department of Family and Community Medicine, College of Medicine-Tucson, The University of Arizona, Tucson, AZ, United States
| | - Robin B Harris
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ, United States
| | - Zhao Chen
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ, United States
| | - Yann C Klimentidis
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ, United States
| | - Melanie L Bell
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ, United States
| | - Kacey C Ernst
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ, United States
| | - Elizabeth T Jacobs
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ, United States.,University of Arizona Cancer Center, Tucson, AZ, United States
| | - Kristen Pogreba-Brown
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, The University of Arizona, Tucson, AZ, United States
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24
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Rains SA, Crane TE, Iyengar S, Merchant N, Oxnam M, Sprinkle MM, Ernst KC. Community-Level Health Promotion during a Pandemic: Key Considerations for Health Communication. Health Commun 2020; 35:1747-1749. [PMID: 33084404 DOI: 10.1080/10410236.2020.1837443] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
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25
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Reyes-Castro PA, Ernst KC, Walker KR, Hayden MH, Alvarez-Hernandez G. Knowledge, Attitudes, and Practices Related to Rocky Mountain Spotted Fever in Hermosillo, México. Am J Trop Med Hyg 2020; 104:184-189. [PMID: 33219641 DOI: 10.4269/ajtmh.20-0181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Rocky Mountain spotted fever (RMSF) is a serious disease in northwest Mexico, particularly in low-income communities. This study aimed to evaluate RMSF-related knowledge, attitudes, and practices in an endemic urban area with a high burden of the disease. A cross-sectional study design using a non-probabilistic household survey was conducted with 400 residents in Hermosillo, Mexico. Primary themes assessed included dog and tick-related exposure, RMSF knowledge, healthcare-seeking behavior, sociodemographic data, and household information. The majority (59%) of those surveyed had heard about RMSF, although only 36% of RMSF-aware respondents knew any RMSF symptoms. Among RMSF-aware respondents, 26% did not know or were unsure of prevention strategies. Individuals in the low socioeconomic status (SES) stratum were less likely to have heard about RMSF (odds ratio [OR]: 0.39; 95% CI: 0.25-0.59), use dog collars or any other product to avoid ticks (OR: 0.40; 95% CI: 0.17-0.99), or check their dogs for ticks (OR: 0.25; 95% CI: 0.09-0.74). The likelihood of observing high numbers of free-roaming dogs in their neighborhood was four times higher in the low SES stratum (OR: 4.19; 95% CI: 2.10-8.38) than in the high SES stratum. These findings emphasize the need for an integrative community approach to improve early recognition of symptoms and knowledge of prevention strategies, particularly in low SES neighborhoods.
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Affiliation(s)
- Pablo A Reyes-Castro
- 1Center of Studies on Health and Society, El Colegio de Sonora, Hermosillo, Mexico
| | | | | | - Mary H Hayden
- 3National Center for Human Resilience, University of Colorado, Colorado Springs, Colorado
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26
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Santos EM, Coalson JE, Munga S, Agawo M, Jacobs ET, Klimentidis YC, Hayden MH, Ernst KC. "After those nets are torn, most people use them for other purposes": an examination of alternative bed net use in western Kenya. Malar J 2020; 19:272. [PMID: 32727452 PMCID: PMC7390200 DOI: 10.1186/s12936-020-03342-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 07/17/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Alternative long-lasting insecticidal net (LLIN) use for purposes other than sleeping protection from mosquitoes is widely debated as a limitation to successful malaria control efforts, yet rarely rigorously studied. METHODS A cross-sectional survey of 1217 households in an epidemic highland site and an endemic lowland site in western Kenya collected information on alternative use in three ways: direct observations, participant self-report, and participant reporting of community-level practices. LLIN misuse was defined as use of an intact net for alternative purposes and repurposing as alternatively using an old or damaged net. Associations between households with observed repurposed nets and universal access and household net use were examined. RESULTS Households describe repurposing nets when they are torn and/or old. Repurposed nets were observed in 8.1% (52/643) highlands households and 33.0% (184/574) lowlands households. Repurposed nets served as chicken coops (33% highlands, 20% lowlands), fences (37% highlands, 25% lowlands), tree covers (22% lowlands), curtains (3% highlands), covering bathrooms (1.5% highlands, 9% lowlands), and washing sponges (13% lowlands). No association was found between repurposing and universal access or household net use. Misuse was rare. Of 379 repurposed nets, 4 (1.06%) were in good condition with no holes. Of 1,758 active nets, 13 (0.74%) were misused. CONCLUSIONS Alternative net use in this study involved repurposing rather than misuse. Repurposing was not detrimental to malaria prevention efforts in these communities. Standardized measurement of alternative net use should be used to better understand the practice and its potential impact on the success of malaria interventions.
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Affiliation(s)
- Ellen M Santos
- Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N Martin Ave, Tucson, AZ, 85724, USA.
| | - Jenna E Coalson
- Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N Martin Ave, Tucson, AZ, 85724, USA
| | - Stephen Munga
- Centre for Global Health Research, Kenya Medical Research Institute, PO Box 1578, Kisumu, 40100, Nyanza, Kenya
| | - Maurice Agawo
- Centre for Global Health Research, Kenya Medical Research Institute, PO Box 1578, Kisumu, 40100, Nyanza, Kenya
| | - Elizabeth T Jacobs
- Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N Martin Ave, Tucson, AZ, 85724, USA
| | - Yann C Klimentidis
- Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N Martin Ave, Tucson, AZ, 85724, USA
| | - Mary H Hayden
- National Institute for Human Resilience, University of Colorado, University Office Park Building 1867 Suite 200, Boulder, CO, 80918, USA
| | - Kacey C Ernst
- Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295 N Martin Ave, Tucson, AZ, 85724, USA
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Jeffrey Gutiérrez EH, Walker KR, Ernst KC, Riehle MA, Davidowitz G. Size as a Proxy for Survival in Aedes aegypti (Diptera: Culicidae) Mosquitoes. J Med Entomol 2020; 57:1228-1238. [PMID: 32266939 PMCID: PMC7768678 DOI: 10.1093/jme/tjaa055] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Indexed: 06/11/2023]
Abstract
The Aedes aegypti mosquito is the primary vector of dengue, yellow fever, chikungunya, and Zika viruses. Infection with the dengue virus alone occurs in an estimated 400 million people each year. Likelihood of infection with a virus transmitted by Ae. aegypti is most commonly attributed to abundance of the mosquito. However, the Arizona-Sonora desert region has abundant Ae. aegypti in most urban areas, yet local transmission of these arboviruses has not been reported in many of these cities. Previous work examined the role of differential Ae. aegypti longevity as a potential explanation for these discrepancies in transmission. To determine factors that were associated with Ae. aegypti longevity in the region, we collected eggs from ovitraps in Tucson, AZ and reared them under multiple experimental conditions in the laboratory to examine the relative impact of temperature and crowding during development, body size, fecundity, and relative humidity during the adult stage. Of the variables studied, we found that the combination of temperature during development, relative humidity, and body size produced the best model to explain variation in age at death. El mosquito Aedes aegypti es el vector primario de los virus de dengue, fiebre amarilla, chikungunya y Zika. Solamente las infecciones con los virus de dengue ocurren en aproximadamente 400 millones de personas cada año. La probabilidad de infección con un virus transmitido por Ae. aegypti es frecuentemente atribuido a la abundancia del mosquito. No obstante, la región del desierto de Arizona-Sonora tiene una abundancia de Ae. aegypti en la mayoría de las áreas urbanas, pero la transmisión local de estos arbovirus no ha sido reportada en muchas de estas ciudades. Trabajos previos han examinado el rol de las diferencias de longevidad en Ae. aegypti como explicación potencial por estas discrepancias en la transmisión. Para determinar que factores fueron asociados con longevidad en Ae. aegypti en la región, colectamos huevos de ovitrampas en Tucson, Arizona y los criamos debajo de múltiples condiciones experimentales en el laboratorio para examinar el impacto relativo de temperatura y competencia para nutrición durante desarrollo, tamaño del cuerpo, capacidad reproductiva, y humedad relativa durante adultez. De las variables estudiados, encontramos que la combinación de temperatura durante desarrollo, humedad relativa, y tamaño del cuerpo produjo el mejor modelo para explicar variación en edad al tiempo de la muerte.
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Affiliation(s)
| | | | - Kacey C Ernst
- Department of Epidemiology and Biostatistics, College of Public Health, University of Arizona, Tucson, AZ
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Coalson JE, Santos EM, Little AC, Anderson EJ, Stroupe N, Agawo M, Hayden M, Munga S, Ernst KC. Insufficient Ratio of Long-Lasting Insecticidal Nets to Household Members Limited Universal Usage in Western Kenya: A 2015 Cross-Sectional Study. Am J Trop Med Hyg 2020; 102:1328-1342. [PMID: 32314696 PMCID: PMC7941599 DOI: 10.4269/ajtmh.19-0119] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 01/22/2020] [Indexed: 11/07/2022] Open
Abstract
Universal "coverage" with long-lasting insecticidal nets (LLINs) is recommended for malaria control in endemic areas, but ownership does not ensure usage. We evaluated relationships between household-level ownership and individual-level usage in western Kenya in 2015. Low-prevalence highland (> 1,500 m) and highly endemic lowland (< 1,200 m) sites were surveyed from July to August 2015. Household members reported long-lasting insecticidal net ownership, use, and barriers to use. Net ownership was categorized as sufficient (≤ 2 people/net), insufficient (> 2 people/net), or none. Each LLIN was assumed to provide access to two people. We surveyed 574 lowland and 643 highland households, with 1,677 and 2,742 members, respectively. More than 98% of lowland households owned LLIN(s); 72.1% owned a sufficient number. Only 37.5% of highland households had sufficient nets. More people used LLINs than were estimated to have access in the lowlands (94.2% versus 85.3%), but proportions were similar in the highlands (54.3% versus 53.3%). Insufficient ownership was most common for larger households in both areas and strongly predicted LLIN usage. In households with insufficient nets, men, school-age children (aged 5-15 years), and nonnuclear family members were less likely to use LLINs; only relationship to the head of the household significantly predicted use in households with sufficient nets. Long-lasting insecticidal nets were widespread in western Kenya in 2015, but insufficient household ownership remained common in the epidemic highlands and in large households. Access seemed to be the primary driver of individual use. To interrupt transmission, LLIN campaigns should improve distribution to large households and promote use among men, school-age children, and nonnuclear family members.
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Affiliation(s)
- Jenna E. Coalson
- Center for Insect Science, University of Arizona, Tucson, Arizona
| | - Ellen M. Santos
- College of Public Health, University of Arizona, Tucson, Arizona
| | - Ashley C. Little
- College of Public Health, University of Arizona, Tucson, Arizona
| | | | - Nancy Stroupe
- College of Public Health, University of Arizona, Tucson, Arizona
| | | | - Mary Hayden
- Trauma, Health and Hazards Center, University of Colorado Colorado Springs, Colorado Springs, Colorado
| | | | - Kacey C. Ernst
- College of Public Health, University of Arizona, Tucson, Arizona
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Anderson EJ, Ernst KC, Martins FF, Martins CDS, Koss MP. Women's Health Perceptions and Beliefs Related to Zika Virus Exposure during the 2016 Outbreak in Northern Brazil. Am J Trop Med Hyg 2020; 102:629-633. [PMID: 31933455 DOI: 10.4269/ajtmh.19-0311] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
During the 2016 Zika pandemic in Brazil, women's perceptions of infection risk, ability to adhere to Zika prevention strategies, or access to services following exposure were not emphasized in the public health response. Women in Fortaleza, Brazil, responded to a questionnaire on social factors related to perceived Zika risk and access to health care in June 2016. Data were coded using prespecified categories, and response frequency was reported. Of 37 respondents, most reported a lack of public services to support mosquito control (n = 19) or delayed access to reproductive health care (n = 14). Only 22% described specific maternal risks or fetal outcomes as a consequence of Zika infection. Respondents indicated an overall disconnect between public health efforts and women's perceptions of their reproductive control, including limited support concerning microcephaly in infants. Interventions targeting Zika may require a greater emphasis on strengthening health systems and infrastructure to realistically prevent transmission.
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Affiliation(s)
| | - Kacey C Ernst
- Department of Epidemiology and Biostatistics, University of Arizona, Tucson, Arizona
| | | | | | - Mary P Koss
- Department of Health Promotion Sciences, University of Arizona, Tucson, Arizona
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Santos EM, McClelland DJ, Shelly CE, Hansen L, Jacobs ET, Klimentidis YC, Ernst KC. Malaria education interventions addressing bed net care and repair practices: a systematic review. Pathog Glob Health 2020; 114:2-15. [PMID: 32000614 DOI: 10.1080/20477724.2020.1719727] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Education intervention effectiveness to improve bed net care and repair knowledge or practices is unclear. To assess intervention effectiveness, we systematically reviewed eight peer-reviewed literature databases and 16 malaria organizations (PROSPERO protocol CRD42019123932) using pre-specified combinations of 'education intervention', 'mosquito net', and 'malaria' search terms. Data were abstracted for 29 of 43 studies meeting inclusion criteria, of which 16 studies included education as amain focus. Of these 16, there was evidence of intervention effectiveness among half of the studies, which reported improvements in knowledge or practices, while four had mixed results, and four had unclear results. Overall there is no clear conclusion regarding the effectiveness of education interventions to improve net care and repair, though some instructional methods suggest more success than others. Interventions used combinations of instructional methods; passive mass education (6), active mass education (12), and interpersonal methods (8). Interventions combining mass and interpersonal methods resulted in positive improvements (four positive, one mixed). We found no evidence that interventions grounded in health behavior theory achieved more positive results than those not grounded in theory, potentially because net care education was typically asecondary objective. Of 289 gray literature results, 286 (99%) were net distribution reports from Against Malaria Foundation describing 136 distributions; eighty of which (58.8%) mentioned no education related to net care and repair. We found lack of involvement of experts in education among included interventions. Involving trained instructors with expertise in education theory and instructional strategies may improve instruction quality to yield more effective interventions.
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Affiliation(s)
- Ellen M Santos
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Deborah J McClelland
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | | | - Lindsay Hansen
- Office of Instruction & Assessment, Manuel Pacheco Integrated Learning Center, University of Arizona, Tucson, AZ, USA
| | - Elizabeth T Jacobs
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Yann C Klimentidis
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Kacey C Ernst
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
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Monaghan AJ, Schmidt CA, Hayden MH, Smith KA, Reiskind MH, Cabell R, Ernst KC. A Simple Model to Predict the Potential Abundance of Aedes aegypti Mosquitoes One Month in Advance. Am J Trop Med Hyg 2019; 100:434-437. [PMID: 30594264 DOI: 10.4269/ajtmh.17-0860] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
The mosquito Aedes (Stegomyia) aegypti (L.) is the primary vector of dengue, chikungunya, and Zika viruses in the United States. Surveillance for adult Ae. aegypti is limited, hindering understanding of the mosquito's seasonal patterns and predictions of areas at elevated risk for autochthonous virus transmission. We developed a simple, intuitive empirical model that uses readily available temperature and humidity variables to predict environmental suitability for low, medium, or high potential abundance of adult Ae. aegypti in a given city 1 month in advance. Potential abundance was correctly predicted in 73% of months in arid Phoenix, AZ (over a 10-year period), and 63% of months in humid Miami, FL (over a 2-year period). The monthly model predictions can be updated daily, weekly, or monthly and thus may be applied to forecast suitable conditions for Ae. aegypti to inform vector-control activities and guide household-level actions to reduce mosquito habitat and human exposure.
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Affiliation(s)
| | | | - Mary H Hayden
- University of Colorado Colorado Springs, Colorado Springs, Colorado
| | - Kirk A Smith
- Maricopa County Environmental Services Vector Control Department, Phoenix, Arizona
| | - Michael H Reiskind
- Department of Entomology, North Carolina State University, Raleigh, North Carolina
| | - Ryan Cabell
- National Center for Atmospheric Research, Boulder, Colorado
| | - Kacey C Ernst
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
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Santos EM, Coalson JE, Jacobs ET, Klimentidis YC, Munga S, Agawo M, Anderson E, Stroupe N, Ernst KC. Bed net care practices and associated factors in western Kenya. Malar J 2019; 18:274. [PMID: 31412865 PMCID: PMC6694604 DOI: 10.1186/s12936-019-2908-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 08/08/2019] [Indexed: 11/22/2022] Open
Abstract
Background Insecticide-treated nets (ITNs) and long-lasting insecticidal nets (LLINs) are effective for malaria prevention and are designed to provide nearly 5 years of mosquito protection. However, many ITNs and LLINs become damaged and ineffective for mosquito bite prevention within 1 to 2 years in field conditions. Non-adherence to recommended bed net care and repair practices may partially explain this shortened net longevity. Methods Using data from a cross-sectional study, a net care adherence score was developed and adherence to net care practices described from two regions of western Kenya. Relationships between attitudes and environmental factors that influence net longevity were measured with adherence to bed net care practices. Results While overall care practices are highly adherent particularly in the highlands, practices related to daily storage, washing frequency, and drying location need improvement in the lowlands. Seventy-seven percent of nets in the lowlands were washed < 3 months prior to the survey compared to 23% of nets in the highlands. More nets were dried in the sun in the lowlands (32% of nets) compared to the highlands (4% of nets). Different elements of care are influenced by various malaria attitudes and environmental factors, highlighting the complexity of factors associated with net care. For example, households that learned about net care from community events, that share a sleeping structure with animals, and that have nets used by adult males tend to adhere to washing frequency recommendations. Conclusions In western Kenya, many nets are cared for in accordance to recommended practices, particularly in the highlands sites. In the lowlands, demonstrating methods at community events to tie nets up during the day coupled with messaging to emphasize infrequent washing and drying nets in the shade may be an appropriate intervention. As illustrated by differences between the highlands and lowlands sites in the present study, should interventions to improve adherence to bed net care practices be necessary, they should be context-specific. Electronic supplementary material The online version of this article (10.1186/s12936-019-2908-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ellen M Santos
- Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295N Martin Ave, Tucson, AZ, 85724, USA.
| | - Jenna E Coalson
- Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295N Martin Ave, Tucson, AZ, 85724, USA
| | - Elizabeth T Jacobs
- Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295N Martin Ave, Tucson, AZ, 85724, USA
| | - Yann C Klimentidis
- Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295N Martin Ave, Tucson, AZ, 85724, USA
| | - Stephen Munga
- Centre for Global Health Research, Kenya Medical Research Institute, PO Box 1578, Kisumu, Nyanza, 40100, Kenya
| | - Maurice Agawo
- Centre for Global Health Research, Kenya Medical Research Institute, PO Box 1578, Kisumu, Nyanza, 40100, Kenya
| | - Elizabeth Anderson
- Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295N Martin Ave, Tucson, AZ, 85724, USA
| | - Nancy Stroupe
- Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295N Martin Ave, Tucson, AZ, 85724, USA
| | - Kacey C Ernst
- Mel and Enid Zuckerman College of Public Health, University of Arizona, 1295N Martin Ave, Tucson, AZ, 85724, USA
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Suppes LM, Ernst KC, Abrell L, Reynolds KA. Validation of Questionnaire Methods to Quantify Recreational Water Ingestion. Int J Environ Res Public Health 2018; 15:E2435. [PMID: 30388798 PMCID: PMC6265721 DOI: 10.3390/ijerph15112435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2018] [Revised: 10/14/2018] [Accepted: 10/19/2018] [Indexed: 11/16/2022]
Abstract
Swimming pool water ingestion volumes are necessary for assessing infection risk from swimming. Pool water ingestion volumes can be estimated by questionnaire or measuring a chemical tracer in swimmer urine. Questionnaires are often preferred to the chemical tracer method because surveys are less time consuming, but no research exists validating questionnaires accurately quantify pool water ingestion volumes. The objective of this study was to explore if questionnaires are a reliable tool for collecting pool water ingestion volumes. A questionnaire was issued at four pool sites in Tucson, Arizona to 46 swimmers who also submitted a urine sample for analyzing cyanuric acid, a chemical tracer. Perceived ingestion volumes reported on the questionnaire were compared with pool water ingestion volumes, quantified by analyzing cyanuric acid in swimmer urine. Swimmers were asked if they swallowed (1) no water or only a few drops, (2) one to two mouthfuls, (3) three to five mouthfuls, or (4) six to eight mouthfuls. One mouthful is the equivalent of 27 mL of water. The majority (81%) of swimmers ingested <27 mL of pool water but reported ingesting >27 mL ("one mouthful") on the questionnaire. More than half (52%) of swimmers overestimated their ingestion volume. These findings suggest swimmers are over-estimating pool water ingestion because they perceive one mouthful is <27 mL. The questionnaire did not reliably collect pool water ingestion volumes and should be improved for future exposure assessment studies. Images of the ingestion volume categories should be included on the questionnaire to help swimmers visualize the response options.
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Affiliation(s)
- Laura M Suppes
- Environmental Public Health Program, The University of Wisconsin-Eau Claire, 105 Garfield Avenue, Eau Claire, WI 54702, USA.
| | - Kacey C Ernst
- Mel and Enid Zuckerman College of Public Health, The University of Arizona, P.O. Box 245163, Tucson, AZ 85724, USA.
| | - Leif Abrell
- Department of Soil, Water & Environmental Science, The University of Arizona, Gould-Simpson Building Room 611, 1040 East 4th Street, Tucson, AZ 85721, USA.
| | - Kelly A Reynolds
- Mel and Enid Zuckerman College of Public Health, The University of Arizona, P.O. Box 245163, Tucson, AZ 85724, USA.
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Ernst KC, Barrett E, Hoswell E, Hayden MH. Increasing women's engagement in vector control: a report from Accelerate To Equal project workshops. Malar J 2018; 17:326. [PMID: 30200986 PMCID: PMC6131753 DOI: 10.1186/s12936-018-2477-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 09/04/2018] [Indexed: 11/29/2022] Open
Abstract
Workshops with academic, national and local government, and community stakeholders were held in Kenya (2017) and Indonesia (2018) to understand the role and perceptions of women in vector control and to identify strategies for accelerating involvement of women in sustained support for vector control interventions at multiple levels/sectors.
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Affiliation(s)
- Kacey C Ernst
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Erika Barrett
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | | | | | - Mary H Hayden
- National Center for Atmospheric Research, Boulder, CO, USA. .,Trauma, Health and Hazards Center, University of Colorado, Colorado Springs, CO, USA.
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Walker KR, Williamson D, Carrière Y, Reyes-Castro PA, Haenchen S, Hayden MH, Jeffrey Gutierrez E, Ernst KC. Socioeconomic and Human Behavioral Factors Associated With Aedes aegypti (Diptera: Culicidae) Immature Habitat in Tucson, AZ. J Med Entomol 2018; 55:955-963. [PMID: 29471405 PMCID: PMC6025186 DOI: 10.1093/jme/tjy011] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Indexed: 05/06/2023]
Abstract
Aedes aegypti (L.; Diptera: Culicidae) has been established in the southwestern United States for several decades, but relationships between humans and mosquitoes in this arid region are not well-characterized. In August 2012, the outdoor premises of 355 houses within 20 neighborhoods in Tucson, Arizona were surveyed for containers that could provide larval habitat for Ae. aegypti mosquitoes. At the same time, a knowledge, attitudes and practices (KAP) questionnaire was administered to a resident of each house surveyed for immature mosquitoes. The KAP questionnaire assessed respondents' knowledge and concerns about vector-borne illnesses as well as practices they used to avoid mosquitoes. Of the houses surveyed, 91% had at least one container present, and 64% had at least one container with standing water. On average, each house had 2.2 containers with water at the time of the survey. The overall House Index (proportion of premises surveyed with at least one container with Ae. aegypti immatures present) was 13%. Based on questionnaire responses, there was a significant positive association between the number of residents in the home and the odds of finding Ae. aegypti positive containers on the premises, while household income showed a significant negative association. The reported frequency of checking for standing water was also significantly associated with the odds of finding immatures, although the nature of this association was ambiguous. Flower pots were the principal type of container with Ae. aegypti larvae. These findings show that larval habitat is widely available even in an arid environment and city with good housing and sanitation infrastructure.
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Affiliation(s)
- Kathleen R Walker
- Department of Entomology, College of Agriculture and Life Sciences, University of Arizona, Tucson, AZ
- Corresponding author, e-mail:
| | - Daniel Williamson
- Department of Entomology, College of Agriculture and Life Sciences, University of Arizona, Tucson, AZ
| | - Yves Carrière
- Department of Entomology, College of Agriculture and Life Sciences, University of Arizona, Tucson, AZ
| | | | - Steven Haenchen
- Department of Epidemiology, College of Public Health, University of Arizona, Tucson, AZ
| | - Mary H Hayden
- Research Applications Laboratory, National Center for Atmospheric Research, Boulder, CO
| | - Eileen Jeffrey Gutierrez
- Department of Entomology, College of Agriculture and Life Sciences, University of Arizona, Tucson, AZ
| | - Kacey C Ernst
- Department of Entomology, College of Agriculture and Life Sciences, University of Arizona, Tucson, AZ
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Asaolu IO, Alaofè H, Gunn JKL, Adu AK, Monroy AJ, Ehiri JE, Hayden MH, Ernst KC. Measuring Women's Empowerment in Sub-Saharan Africa: Exploratory and Confirmatory Factor Analyses of the Demographic and Health Surveys. Front Psychol 2018; 9:994. [PMID: 29971030 PMCID: PMC6018402 DOI: 10.3389/fpsyg.2018.00994] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 05/28/2018] [Indexed: 11/30/2022] Open
Abstract
Background: Women's status and empowerment influence health, nutrition, and socioeconomic status of women and their children. Despite its benefits, however, research on women's empowerment in Sub-Saharan Africa (SSA) is limited in scope and geography. Empowerment is variably defined and data for comparison across regions is often limited. The objective of the current study was to identify domains of empowerment from a widely available data source, Demographic and Health Surveys, across multiple regions in SSA. Methods: Demographic and Health Surveys from nineteen countries representing four African regions were used for the analysis. A total of 26 indicators across different dimensions (economic, socio-cultural, education, and health) were used to characterize women's empowerment. Pooled data from all countries were randomly divided into two datasets—one for exploratory factor analysis (EFA) and the other for Confirmatory Factor Analysis (CFA)—to verify the factor structure hypothesized during EFA. Results: Four factors including attitudes toward violence, labor force participation, education, and access to healthcare were found to define women's empowerment in Central, Southern, and West Africa. However, in East Africa, only three factors were relevant: attitudes toward violence, access to healthcare ranking, and labor force participation. There was limited evidence to support household decision-making, life course, or legal status domains as components of women's empowerment. Conclusion: This foremost study advances scholarship on women's empowerment by providing a validated measure of women's empowerment for researchers and other stakeholders in health and development.
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Affiliation(s)
- Ibitola O Asaolu
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Halimatou Alaofè
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Jayleen K L Gunn
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Akosua K Adu
- Department of Epidemiology, College of Public Health, University of Kentucky, Lexington, KY, United States
| | - Amanda J Monroy
- School of Geography and Development, University of Arizona, Tucson, AZ, United States
| | - John E Ehiri
- Department of Health Promotion Sciences, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
| | - Mary H Hayden
- Climate Science and Applications Program, National Center for Atmospheric Research, Boulder, CO, United States
| | - Kacey C Ernst
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, United States
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Pottinger HL, Jacobs ET, Haenchen SD, Ernst KC. Parental attitudes and perceptions associated with childhood vaccine exemptions in high-exemption schools. PLoS One 2018; 13:e0198655. [PMID: 29902199 PMCID: PMC6002085 DOI: 10.1371/journal.pone.0198655] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 05/21/2018] [Indexed: 11/21/2022] Open
Abstract
Previous work demonstrates that individuals who obtain exemptions from school immunization requirements are geographically clustered, making regional differences in vaccination coverage a significant concern. Even where exemption levels are high, there are still parents that vaccinate. School-level assessments have determined that exemptors are more likely to attend wealthier schools with fewer minorities. Few studies have assessed divergent opinions within the context of a higher-exemption community to examine subtle differences in opinion surrounding vaccinations. Therefore, the objective of this work was to assess attitudes and perceptions towards vaccinations and compare them for exemptors and non-exemptors. We administered surveys to parents in high-exemption (>10%) elementary schools in Arizona during the 2012–13 school year. A total of 404 surveys were completed by parents among schools in Maricopa (n = 7) and Yavapai (n = 2) counties. Of these, 35% (n = 141) were exemptors and 65% (n = 261) were non-exemptors. Exemptors were more likely than non-exemptors to be concerned about serious side-effects (p<0.001). They were more likely to report knowing someone who had been diagnosed with a vaccine-preventable disease (p<0.001) but less likely to report that this had been a serious illness in that person (p<0.001) and they believed it is better for a child to develop immunity through illness than vaccination (p<0.001). They were less likely to trust physicians (p<0.001) and information about vaccines (p<0.001) and were more likely to obtain their health care from a naturopath (p<0.001). In summary, exemptors in these Arizona schools do not appear to be exempting their children from vaccinations due to convenience, as has been hypothesized in other settings. Based on the divergent views within high-exemption schools and reported distrust of the medical establishment, target interventions for high-exemption schools are discussed. Additionally, given the lack of effective non-policy based interventions to-date, the negligible declines in personal belief exemption rates, and vaccine preventable disease rate increases in Arizona, especially in high-exemption areas, legislative action in Arizona may also warrant further investigation.
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Affiliation(s)
- Heidi L. Pottinger
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, United States of America
- * E-mail:
| | - Elizabeth T. Jacobs
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, United States of America
- University of Arizona Cancer Center, University of Arizona, Tucson, Arizona, United States of America
| | - Steven D. Haenchen
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, United States of America
| | - Kacey C. Ernst
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, United States of America
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Schmidt CA, Comeau G, Monaghan AJ, Williamson DJ, Ernst KC. Effects of desiccation stress on adult female longevity in Aedes aegypti and Ae. albopictus (Diptera: Culicidae): results of a systematic review and pooled survival analysis. Parasit Vectors 2018; 11:267. [PMID: 29695282 PMCID: PMC5918765 DOI: 10.1186/s13071-018-2808-6] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Accepted: 03/25/2018] [Indexed: 11/21/2022] Open
Abstract
Background Transmission dynamics of mosquito-borne viruses such as dengue, Zika and chikungunya are affected by the longevity of the adult female mosquito. Environmental conditions influence the survival of adult female Aedes mosquitoes, the primary vectors of these viruses. While the association of temperature with Aedes mortality has been relatively well-explored, the role of humidity is less established. The current study’s goals were to compile knowledge of the influence of humidity on adult survival in the important vector species Aedes aegypti and Ae. albopictus, and to quantify this relationship while accounting for the modifying effect of temperature. Methods We performed a systematic literature review to identify studies reporting experimental results informing the relationships among temperature, humidity and adult survival in Ae. aegypti and Ae. albopictus. Using a novel simulation approach to harmonize disparate survival data, we conducted pooled survival analyses via stratified and mixed effects Cox regression to estimate temperature-dependent associations between humidity and mortality risk for these species across a broad range of temperatures and vapor pressure deficits. Results After screening 1517 articles, 17 studies (one in semi-field and 16 in laboratory settings) met inclusion criteria and collectively reported results for 192 survival experiments. We review and synthesize relevant findings from these studies. Our stratified model estimated a strong temperature-dependent association of humidity with mortality in both species, though associations were not significant for Ae. albopictus in the mixed effects model. Lowest mortality risks were estimated around 27.5 °C and 21.5 °C for Ae. aegypti and Ae. albopictus, respectively, and mortality increased non-linearly with decreasing humidity. Aedes aegypti had a survival advantage relative to Ae. albopictus in the stratified model under most conditions, but species differences were not significant in the mixed effects model. Conclusions Humidity is associated with mortality risk in adult female Ae. aegypti in controlled settings. Data are limited at low humidities, temperature extremes, and for Ae. albopictus, and further studies should be conducted to reduce model uncertainty in these contexts. Desiccation is likely an important factor in Aedes population dynamics and viral transmission in arid regions. Models of Aedes-borne virus transmission may be improved by more comprehensively representing humidity effects. Electronic supplementary material The online version of this article (10.1186/s13071-018-2808-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Chris A Schmidt
- Department of Epidemiology and Biostatistics, Mel & Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave, Tucson, AZ, 85724, USA. .,National Center for Atmospheric Research, P.O. Box 3000, Boulder, CO, 80307, USA.
| | - Genevieve Comeau
- Department of Entomology, College of Agriculture & Life Sciences, University of Arizona, P.O. Box 210036, Tucson, AZ, 85721, USA
| | - Andrew J Monaghan
- National Center for Atmospheric Research, P.O. Box 3000, Boulder, CO, 80307, USA
| | - Daniel J Williamson
- Department of Entomology, College of Agriculture & Life Sciences, University of Arizona, P.O. Box 210036, Tucson, AZ, 85721, USA
| | - Kacey C Ernst
- Department of Epidemiology and Biostatistics, Mel & Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave, Tucson, AZ, 85724, USA.,Department of Entomology, College of Agriculture & Life Sciences, University of Arizona, P.O. Box 210036, Tucson, AZ, 85721, USA
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Hayden MH, Barrett E, Bernard G, Toko EN, Agawo M, Okello AM, Gunn JKL, Ernst KC. Barriers and Opportunities to Advancing Women in Leadership Roles in Vector Control: Perspectives from a Stakeholder Survey. Am J Trop Med Hyg 2018; 98:1224-1227. [PMID: 29557326 PMCID: PMC5953369 DOI: 10.4269/ajtmh.17-0693] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Increasing the active participation of professional women in vector control (VC) activities may help promote greater gender equity in the workplace and reduce the burden of vector-borne diseases. This stakeholder survey examined the current roles and perspective of professionals employed in the VC sector in Kenya, Indonesia, India, and other countries. The largest barriers that women face in pursuing leadership roles in the VC sector include lack of awareness of career opportunities, limitations based on cultural norms, and the belief that VC is men’s work. These barriers could be addressed through improving education and recruitment campaigns, as well as supporting higher education and mentoring programs. Females were almost six times more likely to be encouraged to pursue leadership positions in their organization compared with male respondents (odds ratio = 5.9, P > 0.03, 95% confidence interval: 1.19, 29.42). These findings suggest that once women are recruited into the VC workforce, they face minimal discrimination and have increased leadership opportunities.
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Affiliation(s)
- Mary H Hayden
- Research Applications Laboratory, National Center for Atmospheric Research, Boulder, Colorado
| | - Erika Barrett
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | - Guyah Bernard
- Department of Biomedical Sciences and Technology, School of Public Health and Community Development, Maseno University, Maseno, Nyanza, Kenya
| | - Eunice N Toko
- Department of Biomedical Sciences and Technology, School of Public Health and Community Development, Maseno University, Maseno, Nyanza, Kenya
| | - Maurice Agawo
- Department of Biomedical Sciences and Technology, School of Public Health and Community Development, Maseno University, Maseno, Nyanza, Kenya
| | - Amanda M Okello
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | - Jayleen K L Gunn
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | - Kacey C Ernst
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
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Monaghan AJ, Sampson KM, Steinhoff DF, Ernst KC, Ebi KL, Jones B, Hayden MH. The potential impacts of 21st century climatic and population changes on human exposure to the virus vector mosquito Aedes aegypti. Clim Change 2018; 146:487-500. [PMID: 29610543 PMCID: PMC5877411 DOI: 10.1007/s10584-016-1679-0] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 04/15/2016] [Indexed: 05/23/2023]
Abstract
The mosquito Aedes (Ae). aegypti transmits the viruses that cause dengue and chikungunya, two globally-important vector-borne diseases. We investigate how choosing alternate emissions and/or socioeconomic pathways may modulate future human exposure to Ae. aegypti. Occurrence patterns for Ae. aegypti for 2061-2080 are mapped globally using empirically downscaled air temperature and precipitation projections from the Community Earth System Model, for the Representative Concentration Pathway (RCP) 4.5 and 8.5 scenarios. Population growth is quantified using gridded global population projections consistent with two Shared Socioeconomic Pathways (SSPs), SSP3 and SSP5. Change scenarios are compared to a 1950-2000 reference period. A global land area of 56.9 M km2 is climatically suitable for Ae. aegypti during the reference period, and is projected to increase by 8% (RCP4.5) to 13% (RCP8.5) by 2061-2080. The annual average number of people exposed globally to Ae. aegypti for the reference period is 3794 M, a value projected to statistically significantly increase by 298-460 M (8-12%) by 2061-2080 if only climate change is considered, and by 4805-5084 M (127-134%) for SSP3 and 2232-2483 M (59-65%) for SSP5 considering both climate and population change (lower and upper values of each range represent RCP4.5 and RCP8.5 respectively). Thus, taking the lower-emissions RCP4.5 pathway instead of RCP8.5 may mitigate future human exposure to Ae. aegypti globally, but the effect of population growth on exposure will likely be larger. Regionally, Australia, Europe and North America are projected to have the largest percentage increases in human exposure to Ae. aegypti considering only climate change.
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Affiliation(s)
- A J Monaghan
- National Center for Atmospheric Research, P.O. Box 3000, Boulder, CO 80307
| | - K M Sampson
- National Center for Atmospheric Research, P.O. Box 3000, Boulder, CO 80307
| | - D F Steinhoff
- National Center for Atmospheric Research, P.O. Box 3000, Boulder, CO 80307
| | - K C Ernst
- University of Arizona, College of Public Health, P.O. Box 245163, Tucson, AZ 85724
| | - K L Ebi
- University of Washington, School of Public Health, 1705 NE Pacific St, Box 357965, Seattle, WA 98195-7965
| | - B Jones
- City University of New York, CUNY Institute for Demographic Research, 135 East 22 St, New York, NY 10010
| | - M H Hayden
- National Center for Atmospheric Research, P.O. Box 3000, Boulder, CO 80307
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Gunn JKL, Ernst KC, Center KE, Bischoff K, Nuñez AV, Huynh M, Okello A, Hayden MH. Current strategies and successes in engaging women in vector control: a systematic review. BMJ Glob Health 2018; 3:e000366. [PMID: 29515913 PMCID: PMC5838394 DOI: 10.1136/bmjgh-2017-000366] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 09/13/2017] [Accepted: 11/08/2017] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Vector-borne diseases (VBDs) cause significant mortality and morbidity in low-income and middle-income countries and present a risk to high-income countries. Vector control programmes may confront social and cultural norms that impede their execution. Anecdotal evidence suggests that incorporating women in the design, delivery and adoption of health interventions increases acceptance and compliance. A better understanding of programmes that have attempted to increase women's involvement in vector control could help shape best practices. The objective of this systematic review was to assess and critically summarise evidence regarding the effectiveness of women participating in vector control. METHODS Seven databases were searched from inception to 21 December 2015. Two investigators independently reviewed all titles and abstracts for relevant articles. Grey literature was searched by assessing websites that focus on international development and vector control. RESULTS In total, 23 articles representing 17 unique studies were included in this review. Studies discussed the involvement of women in the control of vectors for malaria (n=10), dengue (n=8), human African trypanosomiasis (n=3), schistosomiasis (n=1) and a combination (malaria and schistosomiasis, n=1). Seven programmes were found in the grey literature or through personal communications. Available literature indicates that women can be successfully engaged in vector control programmes and, when given the opportunity, they can create and sustain businesses that aim to decrease the burden of VBDs in their communities. CONCLUSION This systematic review demonstrated that women can be successfully engaged in vector control programmes at the community level. However, rigorous comparative effectiveness studies need to be conducted.
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Affiliation(s)
- Jayleen K L Gunn
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Kacey C Ernst
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | | | - Kristi Bischoff
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Annabelle V Nuñez
- University of Arizona Health Sciences Library, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Megan Huynh
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Amanda Okello
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, USA
| | - Mary H Hayden
- Research Applications Laboratory, National Center for Atmospheric Research, Boulder, Colorado, USA
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Lwin MO, Jayasundar K, Sheldenkar A, Wijayamuni R, Wimalaratne P, Ernst KC, Foo S. Lessons From the Implementation of Mo-Buzz, a Mobile Pandemic Surveillance System for Dengue. JMIR Public Health Surveill 2017; 3:e65. [PMID: 28970191 PMCID: PMC5643840 DOI: 10.2196/publichealth.7376] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Revised: 04/25/2017] [Accepted: 08/23/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Approximately 128 countries and 3.9 billion people are at risk of dengue infection. Incidence of dengue has increased over the past decades, becoming a growing public health concern for countries with populations that are increasingly susceptible to this vector-borne disease, such as Sri Lanka. Almost 55,150 dengue cases were reported in Sri Lanka in 2016, with more than 30.40% of cases (n=16,767) originating from Colombo, which struggles with an outdated manual paper-based dengue outbreak management system. Community education and outreach about dengue are also executed using paper-based media channels such as pamphlets and brochures. Yet, Sri Lanka is one of the countries with the most affordable rates of mobile services in the world, with penetration rates higher than most developing countries. OBJECTIVES To combat the issues of an exhausted dengue management system and to make use of new technology, in 2015, a mobile participatory system for dengue surveillance called Mo-Buzz was developed and launched in Colombo, Sri Lanka. This paper describes the system's components and uptake, along with other similar disease surveillance systems. METHODS We developed Mo-Buzz and tested its feasibility for dengue. Two versions of the app were developed. The first was for use by public health inspectors (PHIs) to digitize form filling and recording of site visit information, and track dengue outbreaks on a real-time dengue hotspot map using the global positioning system technology. The system also provides updated dengue infographics and educational materials for the PHIs to educate the general public. The second version of Mo-Buzz was created for use by the general public. This system uses dynamic mapping to help educate and inform the general public about potential outbreak regions and allow them to report dengue symptoms and post pictures of potential dengue mosquito-breeding sites, which are automatically sent to the health authorities. Targeted alerts can be sent to users depending on their geographical location. RESULTS We assessed the usage and the usability of the app and its impact on overall dengue transmission in Colombo. Initial uptake of Mo-Buzz for PHIs was low; however, after more training and incentivizing of usage, the uptake of the app in PHIs increased from less than 10% (n=3) to 76% (n=38). The general public user evaluation feedback was fruitful in providing improvements to the app, and at present, a number of solutions are being reviewed as viable options to boost user uptake. CONCLUSIONS From our Mo-Buzz study, we have learned that initial acceptance of such systems can be slow but eventually positive. Mobile and social media interventions, such as Mo-Buzz, are poised to play a greater role in shaping risk perceptions and managing seasonal and sporadic outbreaks of infectious diseases in Asia and around the world.
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Affiliation(s)
- May Oo Lwin
- Wee Kim Wee School of Communication and Information, Nanyang Technological University, Singapore, Singapore
| | - Karthikayen Jayasundar
- Wee Kim Wee School of Communication and Information, Nanyang Technological University, Singapore, Singapore
| | - Anita Sheldenkar
- Wee Kim Wee School of Communication and Information, Nanyang Technological University, Singapore, Singapore
| | | | | | - Kacey C Ernst
- Epidemiology and Biostatistics Department, Mel and Enid Zuckerman College of Public Health, Arizona, AZ, United States
| | - Schubert Foo
- Wee Kim Wee School of Communication and Information, Nanyang Technological University, Singapore, Singapore
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Reyes-Castro PA, Castro-Luque L, Díaz-Caravantes R, Walker KR, Hayden MH, Ernst KC. Outdoor spatial spraying against dengue: A false sense of security among inhabitants of Hermosillo, Mexico. PLoS Negl Trop Dis 2017; 11:e0005611. [PMID: 28520737 PMCID: PMC5448801 DOI: 10.1371/journal.pntd.0005611] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 05/30/2017] [Accepted: 04/28/2017] [Indexed: 11/28/2022] Open
Abstract
Background Government-administered adulticiding is frequently conducted in response to dengue transmission worldwide. Anecdotal evidence suggests that spraying may create a “false sense of security” for residents. Our objective was to determine if there was an association between residents’ reporting outdoor spatial insecticide spraying as way to prevent dengue transmission and both their reported frequency of dengue prevention practices and household entomological indices in Hermosillo, Mexico. Methodology/Principal findings A non-probabilistic survey of 400 households was conducted in August 2014. An oral questionnaire was administered to an adult resident and the outer premises of the home were inspected for water-holding containers and presence of Ae. aegypti larvae and pupae. Self-reported frequency of prevention practices were assessed among residents who reported outdoor spatial spraying as a strategy to prevent dengue (n = 93) and those who did not (n = 307). Mixed effects negative binomial regression was used to assess associations between resident’s reporting spraying as a means to prevent dengue and container indices. Mixed effects logistic regression was used to determine associations with presence/absence of larvae and pupae. Those reporting spatial spraying disposed of trash less frequently and spent less time indoors to avoid mosquitoes. They also used insecticides and larvicides more often and covered their water containers more frequently. Their backyards had more containers positive for Ae. aegypti (RR = 1.92) and there was a higher probability of finding one or more Ae. aegypti pupae (OR = 2.20). Survey respondents that reported spatial spraying prevented dengue were more likely to be older and were exposed to fewer media sources regarding prevention. Conclusions/Significance The results suggest that the perception that outdoor spatial spraying prevents dengue is associated with lower adoption of prevention practices and higher entomological risk. This provides some support to the hypothesis that spraying may lead to a “false sense of security”. Further investigations to clarify this relationship should be conducted. Government campaigns should emphasize the difficulty in controlling Ae. aegypti mosquitoes and the need for both government and community action to minimize risk of dengue transmission. Outdoor spatial spraying is commonly practiced by local governments as a prevention strategy for dengue and other Aedes-borne viruses. However, it has been publically criticized for its potential to reduce community-level actions such as clearance of mosquito habitat due to a resulting “false sense of security”. This study uses a paired social and entomological survey to analyze the association between residents’ perception that outdoor spraying prevents dengue and household level dengue fever prevention practices and entomological indicators in a city in northern Mexico. Our results suggest that those who view dengue is prevented by outdoor spatial spraying had 1) lower frequencies of elimination of potential mosquito breeding sites and higher frequencies of exposure to the vector, 2) higher entomological risk, and 3) a different socio-demographic profile than those who did not report it as effective. Our findings support the possibility that outdoor space spraying may lead to a “false sense of security” which reduces household engagement in prevention activities.
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Affiliation(s)
- Pablo A. Reyes-Castro
- Center for Studies on Health and Society, El Colegio de Sonora, Hermosillo, Sonora, México
- * E-mail:
| | - Lucía Castro-Luque
- Center for Studies on Health and Society, El Colegio de Sonora, Hermosillo, Sonora, México
| | | | | | - Mary H. Hayden
- National Center for Atmospheric Research, Boulder, Colorado, United States of America
| | - Kacey C. Ernst
- University of Arizona, Tucson, Arizona, United States of America
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Gunn JKL, Ehiri JE, Jacobs ET, Ernst KC, Pettygrove S, Center KE, Osuji A, Ogidi AG, Musei N, Obiefune MC, Ezeanolue CO, Ezeanolue EE. Prevalence of Caesarean sections in Enugu, southeast Nigeria: Analysis of data from the Healthy Beginning Initiative. PLoS One 2017; 12:e0174369. [PMID: 28355302 PMCID: PMC5371319 DOI: 10.1371/journal.pone.0174369] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 03/07/2017] [Indexed: 11/29/2022] Open
Abstract
Background In order to meet the Sustainable Development Goal to decrease maternal mortality, increased access to obstetric interventions such as Caesarean sections (CS) is of critical importance. As a result of women’s limited access to routine and emergency obstetric services in Nigeria, the country is a major contributor to the global burden of maternal mortality. In this analysis, we aim to establish rates of CS and determine socioeconomic or medical risk factors associated with having a CS in Enugu, southeast Nigeria. Methods Data for this study originated from the Healthy Beginning Initiative study. Participant characteristics were obtained from 2300 women at baseline via a semi-structured questionnaire. Only women between the ages of 17–45 who had singleton deliveries were retained for this analysis. Post-delivery questionnaires were used to ascertain mode-of-delivery. Crude and adjusted logistic regressions with Caesarean as the main outcome are presented. Results In this sample, 7.22% women had a CS. Compared to women who lived in an urban setting, those who lived in a rural setting had a significant reduction in the odds of having a CS (aOR: 0.58; 0.38–0.89). Significantly higher odds of having a CS were seen among those with high peripheral malaria parasitemia compared to those with low parasitemia (aOR: 1.54; 1.04–2.28). Conclusion This study revealed that contrary to the increasing trend in use of CS in low-income countries, women in this region of Nigeria had limited access to this intervention. Increasing age and socioeconomic proxies for income and access to care (e.g., having a tertiary-level education, full-time employment, and urban residence) were shown to be key determinants of access to CS. Further research is needed to ascertain the obstetric conditions under which women in this region receive CS, and to further elucidate the role of socioeconomic factors in accessing CS.
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Affiliation(s)
- Jayleen K. L. Gunn
- Department of Epidemiology and Biostatistics, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, United States of America
- * E-mail:
| | - John E. Ehiri
- Department of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, United States of America
| | - Elizabeth T. Jacobs
- Department of Epidemiology and Biostatistics, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, United States of America
- University of Arizona Cancer Center, Tucson, Arizona, United States of America
| | - Kacey C. Ernst
- Department of Epidemiology and Biostatistics, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, United States of America
| | - Sydney Pettygrove
- Department of Epidemiology and Biostatistics, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona, United States of America
| | | | - Alice Osuji
- Prevention, Education, Treatment, Training and Research-Global Solutions-PeTR-GS, Enugu, Enugu State, Nigeria
| | - Amaka G. Ogidi
- Prevention, Education, Treatment, Training and Research-Global Solutions-PeTR-GS, Enugu, Enugu State, Nigeria
| | - Nnabundo Musei
- Prevention, Education, Treatment, Training and Research-Global Solutions-PeTR-GS, Enugu, Enugu State, Nigeria
| | - Michael C. Obiefune
- Healthy Sunrise Foundation, Castle Ridge Avenue, Las Vegas, Nevada, United States of America
- Institute of Human Virology, University of Maryland, Baltimore, Maryland, United States of America
| | - Chinenye O. Ezeanolue
- Prevention, Education, Treatment, Training and Research-Global Solutions-PeTR-GS, Enugu, Enugu State, Nigeria
| | - Echezona E. Ezeanolue
- Prevention, Education, Treatment, Training and Research-Global Solutions-PeTR-GS, Enugu, Enugu State, Nigeria
- Healthy Sunrise Foundation, Castle Ridge Avenue, Las Vegas, Nevada, United States of America
- Department of Pediatrics, University of Nevada School of Medicine, Las Vegas, Nevada, United States of America
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Reyes-Castro PA, Harris RB, Brown HE, Christopherson GL, Ernst KC. Spatio-temporal and neighborhood characteristics of two dengue outbreaks in two arid cities of Mexico. Acta Trop 2017; 167:174-182. [PMID: 28062233 DOI: 10.1016/j.actatropica.2017.01.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Revised: 01/02/2017] [Accepted: 01/02/2017] [Indexed: 12/12/2022]
Abstract
Little is currently known about the spatial-temporal dynamics of dengue epidemics in arid areas. This study assesses dengue outbreaks that occurred in two arid cities of Mexico, Hermosillo and Navojoa, located in northern state of Sonora. Laboratory confirmed dengue cases from Hermosillo (N=2730) and Navojoa (N=493) were geocoded by residence and assigned neighborhood-level characteristics from the 2010 Mexican census. Kernel density and Space-time cluster analysis was performed to detect high density areas and space-time clusters of dengue. Ordinary Least Square regression was used to assess the changing socioeconomic characteristics of cases over the course of the outbreaks. Both cities exhibited contiguous patterns of space-time clustering. Initial areas of dissemination were characterized in both cities by high population density, high percentage of occupied houses, and lack of healthcare. Future research and control efforts in these regions should consider these space-time and socioeconomic patterns.
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Affiliation(s)
- Pablo A Reyes-Castro
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA.
| | - Robin B Harris
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Heidi E Brown
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | | | - Kacey C Ernst
- Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
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Chen Z, Klimentidis YC, Bea JW, Ernst KC, Hu C, Jackson R, Thomson CA. Body Mass Index, Waist Circumference, and Mortality in a Large Multiethnic Postmenopausal Cohort-Results from the Women's Health Initiative. J Am Geriatr Soc 2017; 65:1907-1915. [PMID: 28229456 DOI: 10.1111/jgs.14790] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVES To determine whether the relationship between anthropometric measurements of obesity and mortality varies according to age, race, and ethnicity in older women. DESIGN Prospective cohort study of multiethnic postmenopausal women. SETTING Women's Health Initiative (WHI) observational study and clinical trials in 40 clinics. PARTICIPANTS Postmenopausal women aged 50-79 participating in WHI (N = 161,808). MEASUREMENTS Baseline height, weight, and waist circumference (WC) were measured, and body mass index (BMI) was calculated based on height and weight. Demographic, health, and lifestyle data from a baseline questionnaire were used as covariates. The outcome was adjudicated death (n = 18,320) during a mean follow-up of 11.4 ± 3.2 years. RESULTS Hazard ratios (HRs) and 95% confidence intervals (95% CIs) indicated that ethnicity and age modified (P < .01) the relationship between obesity and mortality. Underweight was associated with higher mortality, but overweight or slight obesity was not a risk factor for mortality in most ethnic groups except for Hispanic women in the obesity I category (HR = 1.42, 95% CI = 1.04-1.95). BMI was not or was only weakly associated with mortality in individuals aged 70-79 (HR = 0.90, 95% CI = 0.85-0.95 for overweight; HR = 0.98, 95 CI = 0.92-1.06 for obese I; HR = 1.11, 95% CI = 1.00-1.23 for obese II; HR = 1.08, 95% CI = 0.92-1.26 for obese III). In contrast, higher central obesity measured using WC was consistently associated with higher mortality in all groups. CONCLUSION Underweight is a significant risk factor for mortality in older women, and healthy BMI ranges may need to be specific for age, race, and ethnicity. The findings support a consistent relationship between central obesity and mortality.
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Affiliation(s)
- Zhao Chen
- Mel and Enid Zuckerman College of Public Health, Epidemiology and Biostatistics, University of Arizona, Tucson, Arizona
| | - Yann C Klimentidis
- Mel and Enid Zuckerman College of Public Health, Epidemiology and Biostatistics, University of Arizona, Tucson, Arizona
| | | | - Kacey C Ernst
- Mel and Enid Zuckerman College of Public Health, Epidemiology and Biostatistics, University of Arizona, Tucson, Arizona
| | - Chengcheng Hu
- Mel and Enid Zuckerman College of Public Health, Epidemiology and Biostatistics, University of Arizona, Tucson, Arizona
| | - Rebecca Jackson
- Center for Clinical and Translational Science, Ohio State University, Columbus, Ohio
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Ernst KC, Erly S, Adusei C, Bell ML, Kessie DK, Biritwum-Nyarko A, Ehiri J. Reported bed net ownership and use in social contacts is associated with uptake of bed nets for malaria prevention in pregnant women in Ghana. Malar J 2017; 16:13. [PMID: 28049471 PMCID: PMC5210303 DOI: 10.1186/s12936-016-1660-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2016] [Accepted: 12/15/2016] [Indexed: 11/10/2022] Open
Abstract
Background Despite progress made in the last decades, malaria persists as a pressing health issue in sub-Saharan Africa. Pregnant women are particularly vulnerable to infection and serious health outcomes for themselves and their unborn child. Risk can be mitigated through appropriate use of control measures such as insecticide-treated bed nets. Although social networks can influence uptake of preventive strategies, the role of social influence on bed net ownership has not been explored. During an evaluation of a bed net distribution programme, the influence of non-health care advisors on ownership and use of bed nets by pregnant women in Kumasi, Ghana was examined. Methods Data were collected through in-person interviews with 300 pregnant women seeking antenatal care in an urban hospital in Kumasi, Ghana. Participants were asked about their bed net ownership, bed net use, and information about three personal contacts that they go to for pregnancy advice. Information about these advisors was combined into an influence score. Logistic regression models were used to determine the association between the score and bed net ownership. Those who owned a bed net were further assessed to determine if interpersonal influence was associated with self-reported sleeping under the bed net the previous night. Results Of the 294 women in the analysis, 229 (78%) reported owning bed nets. Of these bed net owners, 139 (61%) reported using a bed net the previous night. A dose response relationship was observed between the interpersonal influence score and bed net ownership and use. Compared to the lowest influence score, those with the highest influence score (>1 SD above the mean) were marginally more likely to own a bed net [OR = 2.37, 95% CI (0.87, 6.39)] and much more likely to use their bed net [5.38, 95% CI (1.89, 15.25)] after adjusting for other factors. Conclusions Interpersonal influence appears to have modest impact on ownership and use of bed nets by pregnant women in an urban area of Ghana. Further investigations would need to be conducted to determine if the relationship is causal or if individuals who associate are simply more likely to have similar practices. Electronic supplementary material The online version of this article (doi:10.1186/s12936-016-1660-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Kacey C Ernst
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Campus PO Box 245211, 1295 N Martin Avenue, Tucson, AZ, 85724, USA.
| | - Steven Erly
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Campus PO Box 245211, 1295 N Martin Avenue, Tucson, AZ, 85724, USA
| | - Charity Adusei
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Campus PO Box 245211, 1295 N Martin Avenue, Tucson, AZ, 85724, USA
| | - Melanie L Bell
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Campus PO Box 245211, 1295 N Martin Avenue, Tucson, AZ, 85724, USA
| | | | | | - John Ehiri
- Department of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Campus PO Box 245211, 1295 N Martin Avenue, Tucson, AZ, 85724, USA
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Ernst KC, Walker KR, Reyes-Castro P, Joy TK, Castro-Luque AL, Diaz-Caravantes RE, Gameros M, Haenchen S, Hayden MH, Monaghan A, Jeffrey-Guttierez E, Carrière Y, Riehle MR. Aedes aegypti (Diptera: Culicidae) Longevity and Differential Emergence of Dengue Fever in Two Cities in Sonora, Mexico. J Med Entomol 2017; 54:204-211. [PMID: 28082648 PMCID: PMC5853638 DOI: 10.1093/jme/tjw141] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 08/08/2016] [Indexed: 05/21/2023]
Abstract
Dengue virus, primarily transmitted by the Aedes aegypti (L.) mosquito, has rapidly expanded in geographic extent over the past several decades. In some areas, however, dengue fever has not emerged despite established Ae. aegypti populations. The reasons for this are unclear and have sometimes been attributed to socio-economic differences. In 2013 we compared Ae. aegypti adult density and population age structure between two cities in Sonora, Mexico: Hermosillo, which has regular seasonal dengue virus transmission, and Nogales, which has minimal transmission. Larval and pupal abundance was greater in Nogales, and adult density was only higher in Hermosillo during September. Population age structure, however, was consistently older in Hermosillo. This difference in longevity may have been one factor that limited dengue virus transmission in Nogales in 2013, as a smaller proportion of Ae. aegypti females survived past the extrinsic incubation period.
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Affiliation(s)
- Kacey C Ernst
- University of Arizona, Tucson, Arizona (; ; ; ; ; ; ; )
| | | | | | - Teresa K Joy
- University of Arizona, Tucson, Arizona (; ; ; ; ; ; ; )
| | | | | | | | | | - Mary H Hayden
- National Center for Atmospheric Research, Boulder, CO (; )
| | | | | | - Yves Carrière
- University of Arizona, Tucson, Arizona (; ; ; ; ; ; ; )
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Haenchen SD, Hayden MH, Dickinson KL, Walker K, Jacobs EE, Brown HE, Gunn JKL, Kohler LN, Ernst KC. Mosquito Avoidance Practices and Knowledge of Arboviral Diseases in Cities with Differing Recent History of Disease. Am J Trop Med Hyg 2016; 95:945-953. [PMID: 27527634 PMCID: PMC5062805 DOI: 10.4269/ajtmh.15-0732] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 04/15/2016] [Indexed: 12/24/2022] Open
Abstract
As the range of dengue virus (DENV) transmission expands, an understanding of community uptake of prevention and control strategies is needed both in geographic areas where the virus has recently been circulating and in areas with the potential for DENV introduction. Personal protective behaviors such as the use of mosquito repellent to limit human-vector contact and the reduction of vector density through elimination of oviposition sites are the primary control methods for Aedes aegypti, the main vector of DENV. Here, we examined personal mosquito control measures taken by individuals in Key West, FL, in 2012, which had experienced a recent outbreak of DENV, and Tucson, AZ, which has a high potential for introduction but has not yet experienced autochthonous transmission. In both cities, there was a positive association between the numbers of mosquitoes noticed outdoors and the overall number of avoidance behaviors, use of repellent, and removal of standing water. Increased awareness and perceived risk of DENV were associated with increases in one of the most effective household prevention behaviors, removal of standing water, but only in Key West.
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Affiliation(s)
| | - Mary H Hayden
- National Center of Atmospheric Research, Boulder, Colorado.
| | - Katherine L Dickinson
- National Center of Atmospheric Research, Boulder, Colorado. University of Colorado Boulder, Boulder, Colorado
| | | | - Elizabeth E Jacobs
- University of Arizona, Tucson, Arizona. University of Arizona Cancer Center, Tucson, Arizona
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Ernst KC, Hayden MH, Olsen H, Cavanaugh JL, Ruberto I, Agawo M, Munga S. Comparing ownership and use of bed nets at two sites with differential malaria transmission in western Kenya. Malar J 2016; 15:217. [PMID: 27079380 PMCID: PMC4832536 DOI: 10.1186/s12936-016-1262-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2015] [Accepted: 03/31/2016] [Indexed: 11/20/2022] Open
Abstract
Background Challenges persist in ensuring access to and optimal use of long-lasting, insecticidal bed nets (LLINs). Factors associated with ownership and use may differ depending on the history of malaria and prevention control efforts in a specific region. Understanding how the cultural and social-environmental context of bed net use may differ between high- and low-risk regions is important when identifying solutions to improve uptake and appropriate use. Methods Community forums and a household, cross-sectional survey were used to collect information on factors related to bed net ownership and use in western Kenya. Sites with disparate levels of transmission were selected, including an endemic lowland area, Miwani, and a highland epidemic-prone area, Kapkangani. Analysis of ownership was stratified by site. A combined site analysis was conducted to examine factors associated with use of all available bed nets. Logistic regression modelling was used to determine factors associated with ownership and use of owned bed nets. Results Access to bed nets as the leading barrier to their use was identified in community forums and cross-sectional surveys. While disuse of available bed nets was discussed in the forums, it was a relatively rare occurrence in both sites. Factors associated with ownership varied by site. Education, perceived risk of malaria and knowledge of individuals who had died of malaria were associated with higher bed net ownership in the highlands, while in the lowlands individuals reporting it was easy to get a bed net were more likely to own one. A combined site analysis indicated that not using an available bed net was associated with the attitudes that taking malaria drugs is easier than using a bed net and that use of a bed net will not prevent malaria. In addition, individuals with an unused bed net in the household were more likely to indicate that bed nets are difficult to use, that purchased bed nets are better than freely distributed ones, and that bed nets should only be used during the rainy season. Conclusion Variations in factors associated with ownership should be acknowledged when constructing messaging and distribution campaigns. Despite reports of bed nets being used for other purposes, those in the home were rarely unused in these communities. Disuse seemed to be related to beliefs that can be addressed through education programmes. As mass distributions continue to take place, additional research is needed to determine if factors associated with LLIN ownership and use change with increasing availability of LLIN.
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Affiliation(s)
- Kacey C Ernst
- Division of Epidemiology and Biostatistics, Mel and Enid Zuckerman School of Public Health, The University of Arizona, 1295 N. Martin Ave., Tucson, AZ, 85724, USA.
| | - Mary H Hayden
- National Center for Atmospheric Research, 3450 Mitchell Lane, Boulder, CO, 80301, USA
| | - Heather Olsen
- Division of Epidemiology and Biostatistics, Mel and Enid Zuckerman School of Public Health, The University of Arizona, 1295 N. Martin Ave., Tucson, AZ, 85724, USA
| | - Jamie L Cavanaugh
- National Center for Atmospheric Research, 3450 Mitchell Lane, Boulder, CO, 80301, USA
| | - Irene Ruberto
- Division of Epidemiology and Biostatistics, Mel and Enid Zuckerman School of Public Health, The University of Arizona, 1295 N. Martin Ave., Tucson, AZ, 85724, USA
| | - Maurice Agawo
- Centre for Global Health Research, Kenyan Medical Research Institute, Kisumu-Busia Highway, Kisumu, Kenya
| | - Stephen Munga
- Centre for Global Health Research, Kenyan Medical Research Institute, Kisumu-Busia Highway, Kisumu, Kenya
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